Provider Demographics
NPI:1215674809
Name:KICZENSKI, KYLEE
Entity type:Individual
Prefix:
First Name:KYLEE
Middle Name:
Last Name:KICZENSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1013 E BEARD RD
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:MI
Mailing Address - Zip Code:48872-9521
Mailing Address - Country:US
Mailing Address - Phone:517-667-8226
Mailing Address - Fax:
Practice Address - Street 1:1013 E BEARD RD
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:MI
Practice Address - Zip Code:48872-9521
Practice Address - Country:US
Practice Address - Phone:517-667-8226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-16
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist