MEDICARE: KYLE AARON BURTON M.D.

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	207R00000X	Internal Medicine Physician	57.028058	OH
2	390200000X	Student in an Organized Health Care Education/Training Program
3	207N00000X	Dermatology Physician	35.139783	OH

General Provider Information

NPI Number	:	1730543455
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYLE AARON BURTON M.D.

Provider Business Mailing Address
First Line	:	2235 VENETIAN COURT
Second Line	:	SUITE 1
City	:	NAPLES
State	:	FL
Zip	:	34109-8728
Country	:	US
Telephone Number	:	239-596-9337
Fax Number	:	239-596-9466

Provider Business Practice Location Address
First Line	:	23471 WALDEN CENTER DRIVE
Second Line	:	SUITE 300
City	:	BONITA SPRINGS
State	:	FL
Zip	:	34134-5016
Country	:	US
Telephone Number	:	239-498-3376
Fax Number	:	239-498-3379

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

Provider Enumeration Date	:	04/08/2016
Last Update Date	:	03/09/2023

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