Healthcare Provider Details

I. General information

NPI: 1912817099
Provider Name (Legal Business Name): AGNIESZKA KILUK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 JOHN R ST
DETROIT MI
48201-2013
US

IV. Provider business mailing address

968 IMPERIAL CRESC
WINDSOR ON
N9G2T2
CA

V. Phone/Fax

Practice location:
  • Phone: 313-527-6266
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License Number4704212670
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: