Provider Demographics
NPI:1457704926
Name:TECOS, KAYLYNN AUDRA (DO)
Entity type:Individual
Prefix:
First Name:KAYLYNN
Middle Name:AUDRA
Last Name:TECOS
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:KAYLYNN
Other - Middle Name:AUDRA
Other - Last Name:CUNEO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:KAYLYNN AUDRA TEMPLE
Mailing Address - Street 1:20825 MACK AVE
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE WOODS
Mailing Address - State:MI
Mailing Address - Zip Code:48236-1485
Mailing Address - Country:US
Mailing Address - Phone:313-881-6900
Mailing Address - Fax:
Practice Address - Street 1:20825 MACK AVE
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE WOODS
Practice Address - State:MI
Practice Address - Zip Code:48236-1485
Practice Address - Country:US
Practice Address - Phone:313-881-6900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-19
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101024602208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5101024602OtherSTATE OF MICHIGAN DEPARTMENT OF LICENSING AND REGULATORY AFFAIRS
MI5315204737OtherSTATE OF MICHIGAN DEPARTMENT OF LICENSING AND REGULATORY AFFAIRS