Healthcare Provider Details

I. General information

NPI: 1497966907
Provider Name (Legal Business Name): KYLE K. RUNNELS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 02/17/2022
Certification Date: 02/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1058 TAMIAMI TRAIL SUITE 108 - 128
SARASOTA FL
34236-2416
US

IV. Provider business mailing address

1058 TAMIAMI TRAIL SUITE 108 - 128
SARASOTA FL
34236-2416
US

V. Phone/Fax

Practice location:
  • Phone: 850-714-4841
  • Fax:
Mailing address:
  • Phone: 850-714-4841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License Number201837
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME149813
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: