Provider Demographics
NPI:1528734993
Name:KRZYWDZINSKI, RYLEE MAE
Entity type:Individual
Prefix:
First Name:RYLEE
Middle Name:MAE
Last Name:KRZYWDZINSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13973 FARMINGTON RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154-5403
Mailing Address - Country:US
Mailing Address - Phone:248-621-4792
Mailing Address - Fax:248-712-4381
Practice Address - Street 1:32260 PIERCE ST
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:MI
Practice Address - Zip Code:48135-3238
Practice Address - Country:US
Practice Address - Phone:734-612-6264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-17
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIK623755572475OtherBEHAVIORAL TECHNICHIAN