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General NPI Number Information
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NPI Number | 1366932311
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Entity Type | Individual
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Provider Name | KYLE MIHAYLO MD
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Gender | Male
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Dates
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Enumeration Date | 05/15/2018
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Last Update Date | 07/01/2022
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Provider Practice Location Address
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Address Line | 1706 S MERIDIAN
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City | PUYALLUP
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State | WA
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Zip | 98371-7516
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Country | US
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Telephone | 253-848-8797
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Fax |
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Provider Business Mailing Address
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Address Line | 1706 S MERIDIAN
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City | PUYALLUP
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State | WA
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Zip | 98371-7516
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Country | US
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Telephone | 253-848-8797
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | MD61296869
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MD61296869
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2080S0010X
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Taxonomy Name | Pediatric Sports Medicine Physician
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License Number | MD61296869
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License Number State | WA
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