Healthcare Provider Details

I. General information

NPI: 1891463584
Provider Name (Legal Business Name): KYLE A LANGFITT AUD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2021
Last Update Date: 09/22/2021
Certification Date: 09/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1434 CHESTER BLVD
RICHMOND IN
47374-1947
US

IV. Provider business mailing address

1100 REID PARKWAY MEDICAL STAFF SERVICE
RICHMOND IN
47374-1157
US

V. Phone/Fax

Practice location:
  • Phone: 765-966-1600
  • Fax: 765-962-9641
Mailing address:
  • Phone: 765-935-5331
  • Fax: 765-983-3219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number23002756A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: