Provider Demographics
NPI:1023557899
Name:CINKOWSKI, KYLE
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:CINKOWSKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11620 BELLETERRE ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:MI
Mailing Address - Zip Code:48133-9702
Mailing Address - Country:US
Mailing Address - Phone:734-735-8708
Mailing Address - Fax:
Practice Address - Street 1:23400 MICHIGAN AVE
Practice Address - Street 2:SUITE P40
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-1928
Practice Address - Country:US
Practice Address - Phone:313-689-5188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-14
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIC522485367404106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician