MEDICARE: DR. WILLIAM SHANE KYLE 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	207Q00000X	Family Medicine Physician	10972	NV

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

General Provider Information

NPI Number	:	1598707853
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM SHANE KYLE M.D.

Provider Business Mailing Address
First Line	:	PO BOX 629
Second Line	:
City	:	ALTOONA
State	:	IA
Zip	:	50009-0629
Country	:	US
Telephone Number	:	515-645-9911
Fax Number	:	515-967-5581

Provider Business Practice Location Address
First Line	:	10561 JEFFREYS ST
Second Line	:	SUITE 100
City	:	HENDERSON
State	:	NV
Zip	:	89052-4266
Country	:	US
Telephone Number	:	702-478-5620
Fax Number	:	702-478-5093

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

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	09/16/2014

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