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1407956923

NPI Code Detail

MEDICARE: DR. JAMES RICHARD KYLER M.D.

MEDICARE: DR. JAMES RICHARD KYLER M.D.

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	207N00000X	Dermatology Physician	10134247A	IN
2	207NS0135X	Procedural Dermatology Physician	10134247A	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00099686	OTHER		MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1494	OTHER		PHP
2	4228227	OTHER		AETNA
4	000000308074	OTHER		BCBS
5	01034247A	OTHER	IN	STATE LICENSE NUMBER
6	01034247B	OTHER	IN	CSR LICENSE NUMBER
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407956923
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES RICHARD KYLER M.D.

Provider Business Mailing Address
First Line	:	5750 FALLS DR
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-7147
Country	:	US
Telephone Number	:	260-436-8000
Fax Number	:	260-432-5587

Provider Business Practice Location Address
First Line	:	5750 FALLS DR
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-7147
Country	:	US
Telephone Number	:	260-436-8000
Fax Number	:	260-432-5587

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

Provider Enumeration Date	:	09/24/2006
Last Update Date	:	03/07/2023

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1790883502 — MS. NICOLE MARIE HELSOM P.A.
Practice Location Address:

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Directions to “ DR. JAMES RICHARD KYLER M.D.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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