MEDICARE: DR. KYLE D. LOY M.D. P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207YX0905X	Otolaryngology/Facial Plastic Surgery Physician	01026301A	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00215064	OTHER	IN	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	000000361234	OTHER	IN	ANTHEM PIN

General Provider Information

NPI Number	:	1528040045
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KYLE D. LOY M.D. P.C.

Provider Business Mailing Address
First Line	:	2606 VETERANS MEMORIAL PKWY S
Second Line	:	SUITE 1
City	:	LAFAYETTE
State	:	IN
Zip	:	47909-9192
Country	:	US
Telephone Number	:	765-474-4500
Fax Number	:	765-474-1122

Provider Business Practice Location Address
First Line	:	2606 VETERANS MEMORIAL PKWY S
Second Line	:	SUITE 1
City	:	LAFAYETTE
State	:	IN
Zip	:	47909-9192
Country	:	US
Telephone Number	:	765-474-4500
Fax Number	:	765-474-1122

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/18/2005
Last Update Date	:	11/01/2012

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Directions to “ DR. KYLE D. LOY M.D. P.C.” Practice Location

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