MEDICARE: KAYLEN B SLATER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	247200000X	Other Technician		MI

General Provider Information

NPI Number	:	1386399459
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLEN B SLATER

Provider Business Mailing Address
First Line	:	11431 WHITEHILL ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48224-1652
Country	:	US
Telephone Number	:	313-918-6682
Fax Number	:

Provider Business Practice Location Address
First Line	:	11431 WHITEHILL ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48224-1652
Country	:	US
Telephone Number	:	313-918-6682
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/17/2022
Last Update Date	:	02/17/2022

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Directions to “ KAYLEN B SLATER ” Practice Location

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