Healthcare Provider Details

I. General information

NPI: 1679268478
Provider Name (Legal Business Name): KYLE STEPHEN KOTLEBA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2023
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 LOCUST STREET SUITE 10517
PITTSBURGH PA
15219-5166
US

IV. Provider business mailing address

3600 FORBES AVENUE FORBES TOWER-PLAZA LEVEL SUITE 140
PITTSBURGH PA
15213-5166
US

V. Phone/Fax

Practice location:
  • Phone: 412-232-4065
  • Fax: 412-232-5689
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2026036666
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: