Provider Demographics
NPI:1487138020
Name:KLEYN, KENNETH ALLEN (MD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:ALLEN
Last Name:KLEYN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5548 MILLBROOK DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:MI
Mailing Address - Zip Code:49690-9214
Mailing Address - Country:US
Mailing Address - Phone:231-649-0559
Mailing Address - Fax:
Practice Address - Street 1:5548 MILLBROOK DR
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:MI
Practice Address - Zip Code:49690-9214
Practice Address - Country:US
Practice Address - Phone:231-649-0559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-19
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301023732207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine