Healthcare Provider Details

I. General information

NPI: 1730543455
Provider Name (Legal Business Name): KYLE AARON BURTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2016
Last Update Date: 03/09/2023
Certification Date: 03/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23471 WALDEN CENTER DRIVE SUITE 300
BONITA SPRINGS FL
34134-5016
US

IV. Provider business mailing address

2235 VENETIAN COURT SUITE 1
NAPLES FL
34109-8728
US

V. Phone/Fax

Practice location:
  • Phone: 239-498-3376
  • Fax: 239-498-3379
Mailing address:
  • Phone: 239-596-9337
  • Fax: 239-596-9466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number57.028058
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number35.139783
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: