Provider Demographics
NPI:1568057818
Name:ADESINA, KHIA S (LMT)
Entity Type:Individual
Prefix:MS
First Name:KHIA
Middle Name:S
Last Name:ADESINA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33045 PARKHILL ST APT 202
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:MI
Mailing Address - Zip Code:48184-1339
Mailing Address - Country:US
Mailing Address - Phone:248-897-6431
Mailing Address - Fax:
Practice Address - Street 1:24567 NORTHWESTERN HWY STE 302A
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-2412
Practice Address - Country:US
Practice Address - Phone:248-897-6431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-08
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist