Healthcare Provider Details

I. General information

NPI: 1093166928
Provider Name (Legal Business Name): KAYLA JELINEK D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2016
Last Update Date: 09/22/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16360 26 MILE RD
MACOMB MI
48042-1057
US

IV. Provider business mailing address

3535 W 13 MILE RD MOB STE 233
ROYAL OAK MI
48073-6770
US

V. Phone/Fax

Practice location:
  • Phone: 313-874-4806
  • Fax:
Mailing address:
  • Phone: 248-551-0845
  • Fax: 248-551-3130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number5101022525
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: