Provider Demographics
NPI:1881113496
Name:CLEYPOOL, KATELYN MARIE (DPM)
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:MARIE
Last Name:CLEYPOOL
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36475 FIVE MILE RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-1971
Mailing Address - Country:US
Mailing Address - Phone:734-655-4800
Mailing Address - Fax:734-655-2911
Practice Address - Street 1:36475 FIVE MILE RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154-1971
Practice Address - Country:US
Practice Address - Phone:734-655-4800
Practice Address - Fax:734-655-2911
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-14
Last Update Date:2025-05-29
Deactivation Date:2022-03-25
Deactivation Code:
Reactivation Date:2022-04-18
Provider Licenses
StateLicense IDTaxonomies
390200000X
MI5901400565213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program