Provider Demographics
NPI:1699201707
Name:STEFANKO, KAYLA (DO)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:STEFANKO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8950 PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:CADILLAC
Mailing Address - State:MI
Mailing Address - Zip Code:49601-8599
Mailing Address - Country:US
Mailing Address - Phone:231-876-1101
Mailing Address - Fax:231-775-2570
Practice Address - Street 1:8950 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601-8599
Practice Address - Country:US
Practice Address - Phone:231-876-1101
Practice Address - Fax:231-775-2570
Is Sole Proprietor?:No
Enumeration Date:2017-05-10
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101022990207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5101022990OtherLICENSE