Provider Demographics
NPI:1770048373
Name:KYCIA, KILEE ADDISON BAYNE (DO)
Entity type:Individual
Prefix:DR
First Name:KILEE
Middle Name:ADDISON BAYNE
Last Name:KYCIA
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 1:4031 BRUCE DR SE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-2719
Mailing Address - Country:US
Mailing Address - Phone:860-930-4441
Mailing Address - Fax:
Practice Address - Street 1:1932 NILES CORTLAND RD NE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-1055
Practice Address - Country:US
Practice Address - Phone:330-856-2520
Practice Address - Fax:330-856-2530
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-07
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.017227207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH207Y00000XOtherHOSPITAL