MEDICARE: DR. KYLE MIKALS 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	207R00000X	Internal Medicine Physician	ME172811	FL
2	207R00000X	Internal Medicine Physician	0101260378	VA

General Provider Information

NPI Number	:	1730504879
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KYLE MIKALS M.D.

Provider Business Mailing Address
First Line	:	7643 GATE PKWY STE 104-909
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-3092
Country	:	US
Telephone Number	:	904-925-8540
Fax Number	:	904-901-8673

Provider Business Practice Location Address
First Line	:	7643 GATE PKWY STE 104-909
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-3092
Country	:	US
Telephone Number	:	904-925-8540
Fax Number	:	904-901-8673

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

Provider Enumeration Date	:	02/26/2014
Last Update Date	:	12/12/2025

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