Healthcare Provider Details

I. General information

NPI: 1093923468
Provider Name (Legal Business Name): KYLE T JUDD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 08/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 ELMWOOD AVE, BOX 665
ROCHESTER NY
14642
US

IV. Provider business mailing address

601 ELMWOOD AVE, BOX 665
ROCHESTER NY
14642
US

V. Phone/Fax

Practice location:
  • Phone: 585-276-7790
  • Fax: 585-276-2497
Mailing address:
  • Phone: 585-276-7790
  • Fax: 585-276-2497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number47303
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD47303
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number8302
License Number StateSD
# 4
Primary TaxonomyY
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number278850
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: