Provider Demographics
NPI:1336553239
Name:WILLSEY, KYLENE (MD)
Entity Type:Individual
Prefix:
First Name:KYLENE
Middle Name:
Last Name:WILLSEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KYLENE
Other - Middle Name:
Other - Last Name:WOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:13699 E OLD US HIGHWAY 12
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:MI
Mailing Address - Zip Code:48118-9664
Mailing Address - Country:US
Mailing Address - Phone:734-475-4500
Mailing Address - Fax:734-475-4507
Practice Address - Street 1:13699 E OLD US HIGHWAY 12
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:MI
Practice Address - Zip Code:48118
Practice Address - Country:US
Practice Address - Phone:734-475-4500
Practice Address - Fax:734-475-4507
Is Sole Proprietor?:No
Enumeration Date:2014-06-18
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301105815208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics