Healthcare Provider Details

I. General information

NPI: 1023699204
Provider Name (Legal Business Name): KYLE WILLIAM MCLOUTH DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2021
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4235 SECOR RD
TOLEDO OH
43623-4299
US

IV. Provider business mailing address

4235 SECOR RD FL OH43623
TOLEDO OH
43623-4299
US

V. Phone/Fax

Practice location:
  • Phone: 419-479-5529
  • Fax: 419-479-5479
Mailing address:
  • Phone: 419-479-5529
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number5101028130
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number34.018539
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: