Provider Demographics
NPI:1063426468
Name:KILEY, KEVIN M (MD)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:M
Last Name:KILEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 1848
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49443-1848
Mailing Address - Country:US
Mailing Address - Phone:231-727-5211
Mailing Address - Fax:231-727-4571
Practice Address - Street 1:1909 RUDDIMAN DRIVE
Practice Address - Street 2:
Practice Address - City:NORTH MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49445
Practice Address - Country:US
Practice Address - Phone:231-744-5577
Practice Address - Fax:231-744-8777
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2018-02-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301052245207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4556422Medicaid
A73546Medicare UPIN
MIN28430065Medicare PIN