Provider Demographics
NPI:1699715508
Name:DAYMON, KEVIN M (CRNA)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:M
Last Name:DAYMON
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 NORTH PERRY
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48342
Mailing Address - Country:US
Mailing Address - Phone:248-338-5000
Mailing Address - Fax:248-338-5547
Practice Address - Street 1:50 NORTH PERRY
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48342
Practice Address - Country:US
Practice Address - Phone:248-338-5000
Practice Address - Fax:248-338-5547
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704190088367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIKD190088OtherBCBS
MIS49326Medicare UPIN