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NPI Code Detail

MEDICARE: KYLE FONTAINE

MEDICARE: KYLE FONTAINE
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
1390200000XStudent in an Organized Health Care Education/Training ProgramUO11400FL

General Provider Information

NPI Number : 1538090543
Entity Type Code : Individual
Provider Name (Legal Business Name) : KYLE FONTAINE
Provider Business Mailing Address
First Line : 7727 LAKE UNDERHILL RD
Second Line :
City : ORLANDO
State : FL
Zip : 32822-8224
Country : US
Telephone Number : 407-303-6413
Fax Number :
Provider Business Practice Location Address
First Line : 7727 LAKE UNDERHILL RD
Second Line :
City : ORLANDO
State : FL
Zip : 32822-8224
Country : US
Telephone Number : 407-303-6413
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/27/2026
Last Update Date : 05/27/2026

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Directions to “ KYLE FONTAINE ” Practice Location

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