Healthcare Provider Details

I. General information

NPI: 1588043046
Provider Name (Legal Business Name): KYLE DOUGLAS CHECCHI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2015
Last Update Date: 02/24/2025
Certification Date: 02/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NMRTC OKINAWA DEPARTMENT OF GENERAL SURGERY
CAMP FOSTER OKINAWA
96362
JP

IV. Provider business mailing address

3D MEDICAL BATTALION
CAMP FOSTER OKINAWA
96373
JP

V. Phone/Fax

Practice location:
  • Phone: 315-646-7148
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License NumberA143691
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA143691
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number036170464
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: