Healthcare Provider Details

I. General information

NPI: 1720469117
Provider Name (Legal Business Name): KILIAN FULIE FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: KILIAN FULIE FNP

II. Dates (important events)

Enumeration Date: 06/11/2015
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51362 BRUSHFORD DR
CHESTERFIELD MI
48047-3175
US

IV. Provider business mailing address

51362 BRUSHFORD DR
CHESTERFIELD MI
48047-3175
US

V. Phone/Fax

Practice location:
  • Phone: 248-571-2274
  • Fax:
Mailing address:
  • Phone: 248-571-2274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704345633
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704345633NSA23
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: