Provider Demographics
NPI:1285417691
Name:MILLER-KYLES, KAIJA
Entity type:Individual
Prefix:
First Name:KAIJA
Middle Name:
Last Name:MILLER-KYLES
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 1:12201 W NORTH AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-2061
Mailing Address - Country:US
Mailing Address - Phone:262-777-1729
Mailing Address - Fax:
Practice Address - Street 1:12201 W NORTH AVE STE 205
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-2061
Practice Address - Country:US
Practice Address - Phone:262-777-1729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-17
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator