Provider Demographics
NPI:1518464106
Name:MCKECHNIE, TYSON REED
Entity Type:Individual
Prefix:
First Name:TYSON
Middle Name:REED
Last Name:MCKECHNIE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HENRY FORD WYANDOTTE HOSPITAL, MEDICAL EDUCATION DEPT.
Mailing Address - Street 2:2333 BIDDLE AVE.
Mailing Address - City:WYANDOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48192
Mailing Address - Country:US
Mailing Address - Phone:802-373-6858
Mailing Address - Fax:
Practice Address - Street 1:HENRY FORD WYANDOTTE HOSPITAL, MEDICAL EDUCATION DEPT.
Practice Address - Street 2:2333 BIDDLE AVE.
Practice Address - City:WYANDOTTE
Practice Address - State:MI
Practice Address - Zip Code:48192
Practice Address - Country:US
Practice Address - Phone:802-373-6858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-10
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MI5101023990207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program