MEDICARE: KYLE E HOOGENDOORN DPM

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	213E00000X	Podiatrist	1844	TX

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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629135157
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYLE E HOOGENDOORN DPM

Provider Business Mailing Address
First Line	:	6048 LAKE WORTH BLVD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76135-3706
Country	:	US
Telephone Number	:	817-336-1189
Fax Number	:	817-698-8281

Provider Business Practice Location Address
First Line	:	6048 LAKE WORTH BLVD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76135-3706
Country	:	US
Telephone Number	:	817-336-1189
Fax Number	:	817-698-8281

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

Provider Enumeration Date	:	01/03/2007
Last Update Date	:	11/03/2015

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