MEDICARE: DR. KYLE VAN SCHWICKERATH DPM

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	213ES0103X	Foot & Ankle Surgery Podiatrist	POD-001091	AZ

General Provider Information

NPI Number	:	1245857101
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KYLE VAN SCHWICKERATH DPM

Provider Business Mailing Address
First Line	:	26900 N LAKE PLEASANT PKWY STE 202
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85383-1558
Country	:	US
Telephone Number	:	623-254-7111
Fax Number	:	623-254-7100

Provider Business Practice Location Address
First Line	:	26900 N LAKE PLEASANT PKWY STE 202
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85383-1558
Country	:	US
Telephone Number	:	623-254-7111
Fax Number	:	623-254-7100

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

Provider Enumeration Date	:	06/26/2020
Last Update Date	:	09/10/2025

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