MEDICARE: DR. KYLE OWEN MOUNTS 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	2080N0001X	Neonatal-Perinatal Medicine Physician	35239	WI

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	:	1639264187
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KYLE OWEN MOUNTS M.D.

Provider Business Mailing Address
First Line	:	3070 NORTH 51ST ST.
Second Line	:	SUITE P309
City	:	MILWAUKEE
State	:	WI
Zip	:	53210-1661
Country	:	US
Telephone Number	:	414-447-2663
Fax Number	:	414-447-1070

Provider Business Practice Location Address
First Line	:	3070 NORTH 51ST ST.
Second Line	:	SUITE P309
City	:	MILWAUKEE
State	:	WI
Zip	:	53210-1661
Country	:	US
Telephone Number	:	414-447-2663
Fax Number	:	414-447-1070

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

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	07/08/2007

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