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General NPI Number Information
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NPI Number | 1396163390
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Entity Type | Individual
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Provider Name | KYLEIGH NAISMITH DO
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Gender | Female
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Dates
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Enumeration Date | 04/07/2014
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Last Update Date | 01/17/2019
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Provider Practice Location Address
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Address Line | 2420 OWEN RD STE A
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City | FENTON
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State | MI
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Zip | 48430-3417
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Country | US
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Telephone | 810-496-2500
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Fax | 810-629-0415
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Provider Business Mailing Address
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Address Line | PO BOX 775316
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City | CHICAGO
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State | IL
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Zip | 60677-5316
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 5101021319
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License Number State | MI
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