Healthcare Provider Details

I. General information

NPI: 1225910433
Provider Name (Legal Business Name): KALEEYSE ELA MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2025
Last Update Date: 07/21/2025
Certification Date: 07/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8600 WOODWARD AVE
DETROIT MI
48202-2142
US

IV. Provider business mailing address

882 OAKMAN BLVD STE D
DETROIT MI
48238-4019
US

V. Phone/Fax

Practice location:
  • Phone: 313-875-7601
  • Fax:
Mailing address:
  • Phone: 956-789-8258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: