MEDICARE: DR. KYLE ANTHONY O'BLANC MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	2018014429	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013116458
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KYLE ANTHONY O'BLANC MD

Provider Business Mailing Address
First Line	:	1825 HIGH OAK RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63131-1501
Country	:	US
Telephone Number	:	504-710-8234
Fax Number	:

Provider Business Practice Location Address
First Line	:	1825 HIGH OAK RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63131-1501
Country	:	US
Telephone Number	:	504-710-8234
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/16/2007
Last Update Date	:	11/15/2021

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