Healthcare Provider Details

I. General information

NPI: 1265137236
Provider Name (Legal Business Name): KYLE MICHAEL ALPHA MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2023
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 PROSPECT AVE
SYRACUSE NY
13203-1899
US

IV. Provider business mailing address

301 PROSPECT AVE
SYRACUSE NY
13203-1899
US

V. Phone/Fax

Practice location:
  • Phone: 315-448-5111
  • Fax: 315-448-6313
Mailing address:
  • Phone: 315-448-5111
  • Fax: 857-270-7205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number332023
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number332023
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number332023
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: