Healthcare Provider Details

I. General information

NPI: 1518464106
Provider Name (Legal Business Name): TYSON REED MCKECHNIE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2018
Last Update Date: 02/18/2026
Certification Date: 02/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HENRY FORD WYANDOTTE HOSPITAL, MEDICAL EDUCATION DEPT. 2333 BIDDLE AVE.
WYANDOTTE MI
48192
US

IV. Provider business mailing address

HENRY FORD WYANDOTTE HOSPITAL, MEDICAL EDUCATION DEPT. 2333 BIDDLE AVE.
WYANDOTTE MI
48192
US

V. Phone/Fax

Practice location:
  • Phone: 802-373-6858
  • Fax:
Mailing address:
  • Phone: 802-373-6858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number032.0133952
License Number StateVT
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number341580
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number5101023990
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: