MEDICARE: KYLE MCCLINTOCK

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	237700000X	Hearing Instrument Specialist	037-3028	IL

General Provider Information

NPI Number	:	1679000772
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYLE MCCLINTOCK

Provider Business Mailing Address
First Line	:	7800 N SOMMER ST STE 305
Second Line	:
City	:	PEORIA
State	:	IL
Zip	:	61615-1994
Country	:	US
Telephone Number	:	309-685-0887
Fax Number	:

Provider Business Practice Location Address
First Line	:	7800 N SOMMER ST STE 305
Second Line	:
City	:	PEORIA
State	:	IL
Zip	:	61615-1994
Country	:	US
Telephone Number	:	309-685-0887
Fax Number	:	309-685-0887

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

Provider Enumeration Date	:	05/19/2017
Last Update Date	:	02/25/2020

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Directions to “ KYLE MCCLINTOCK ” Practice Location

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