Healthcare Provider Details

I. General information

NPI: 1659597102
Provider Name (Legal Business Name): KYLE PATRICK D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 03/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7449 E OSBORN RD SUITE 3
SCOTTSDALE AZ
85251-6448
US

IV. Provider business mailing address

7449 E OSBORN RD SUITE 3
SCOTTSDALE AZ
85251-6448
US

V. Phone/Fax

Practice location:
  • Phone: 480-206-3276
  • Fax:
Mailing address:
  • Phone: 480-206-3276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number3496
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: