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General NPI Number Information
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NPI Number | 1942795802
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Entity Type | Individual
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Provider Name | KYLE R MARDEN MD
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Gender | Male
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Dates
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Enumeration Date | 06/24/2018
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Last Update Date | 09/22/2025
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Provider Practice Location Address
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Address Line | 259 E ERIE ST STE 1900
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City | CHICAGO
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State | IL
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Zip | 60611-3246
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Country | US
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Telephone | 312-695-7950
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Fax | 312-695-5747
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Provider Business Mailing Address
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Address Line | 259 E ERIE ST FL 19
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City | CHICAGO
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State | IL
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Zip | 60611-2987
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Country | US
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Telephone | 312-695-7950
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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 | 2084S0010X
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Taxonomy Name | Sports Medicine (Psychiatry & Neurology) Physician
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License Number | ME160945
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2084N0008X
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Taxonomy Name | Neuromuscular Medicine (Psychiatry & Neurology) Physician
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License Number | MT230624
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 036174026
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | ME160945
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License Number State | FL
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