Healthcare Provider Details

I. General information

NPI: 1740523331
Provider Name (Legal Business Name): KYLE M YODER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2013
Last Update Date: 07/21/2022
Certification Date: 12/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 ARCH ST STE G2
AKRON OH
44304-1430
US

IV. Provider business mailing address

75 ARCH ST STE G2
AKRON OH
44304-1430
US

V. Phone/Fax

Practice location:
  • Phone: 330-375-3039
  • Fax:
Mailing address:
  • Phone: 330-375-3039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number34.012094
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: