Provider Demographics
NPI:1457704926
Name:TEMPLE, KAYLYNN AUDRA (DO)
Entity Type:Individual
Prefix:
First Name:KAYLYNN
Middle Name:AUDRA
Last Name:TEMPLE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:KAYLYNN
Other - Middle Name:AUDRA
Other - Last Name:CUNEO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:21700 ALLEN RD
Mailing Address - Street 2:
Mailing Address - City:WOODHAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:48183-1604
Mailing Address - Country:US
Mailing Address - Phone:734-671-8660
Mailing Address - Fax:
Practice Address - Street 1:21700 ALLEN RD
Practice Address - Street 2:
Practice Address - City:WOODHAVEN
Practice Address - State:MI
Practice Address - Zip Code:48183-1604
Practice Address - Country:US
Practice Address - Phone:734-671-8660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-19
Last Update Date:2019-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101024602208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5315204737OtherSTATE OF MICHIGAN DEPARTMENT OF LICENSING AND REGULATORY AFFAIRS
MI5101024602OtherSTATE OF MICHIGAN DEPARTMENT OF LICENSING AND REGULATORY AFFAIRS