Healthcare Provider Details

I. General information

NPI: 1770025660
Provider Name (Legal Business Name): MICHELLE KUYKENDALL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2016
Last Update Date: 12/31/2024
Certification Date: 12/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27777 INKSTER RD STE 100
FARMINGTON HILLS MI
48334-5312
US

IV. Provider business mailing address

2502 OAK HILL OVERLOOK
DULUTH GA
30097-7413
US

V. Phone/Fax

Practice location:
  • Phone: 855-772-8847
  • Fax:
Mailing address:
  • Phone: 404-428-4944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: