Healthcare Provider Details

I. General information

NPI: 1457704926
Provider Name (Legal Business Name): KAYLYNN AUDRA TECOS DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAYLYNN AUDRA CUNEO KAYLYNN AUDRA TEMPLE

II. Dates (important events)

Enumeration Date: 07/19/2016
Last Update Date: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20825 MACK AVE
GROSSE POINTE WOODS MI
48236-1485
US

IV. Provider business mailing address

20825 MACK AVE
GROSSE POINTE WOODS MI
48236-1485
US

V. Phone/Fax

Practice location:
  • Phone: 313-881-6900
  • Fax:
Mailing address:
  • Phone: 313-881-6900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number5101024602
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: