Healthcare Provider Details

I. General information

NPI: 1972820280
Provider Name (Legal Business Name): KYLE J LEGRAND DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2010
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2156 CHAMBER CENTER DR
LAKESIDE PARK KY
41017-1669
US

IV. Provider business mailing address

2156 CHAMBER CENTER DR
LAKESIDE PARK KY
41017-1669
US

V. Phone/Fax

Practice location:
  • Phone: 859-341-6255
  • Fax: 859-547-1197
Mailing address:
  • Phone: 859-341-6255
  • Fax: 859-547-1197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34.010312
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number04492
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number02008615A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: