Healthcare Provider Details

I. General information

NPI: 1578556544
Provider Name (Legal Business Name): MICHAEL L KYLE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 12/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 LAKE ST
OAK PARK IL
60301
US

IV. Provider business mailing address

172 SCHILLER
ELMHURST IL
60126-2885
US

V. Phone/Fax

Practice location:
  • Phone: 708-524-1420
  • Fax:
Mailing address:
  • Phone: 630-993-5676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number036096088
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036-096088
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: