Healthcare Provider Details

I. General information

NPI: 1336553239
Provider Name (Legal Business Name): KYLENE WILLSEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KYLENE WOOD M.D.

II. Dates (important events)

Enumeration Date: 06/18/2014
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7444 DEXTER ANN ARBOR RD STE A
DEXTER MI
48130-1468
US

IV. Provider business mailing address

7444 DEXTER ANN ARBOR RD STE A
DEXTER MI
48130-1468
US

V. Phone/Fax

Practice location:
  • Phone: 734-408-4182
  • Fax: 734-253-2565
Mailing address:
  • Phone: 734-408-4182
  • Fax: 734-253-2565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301105815
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: