MEDICARE: KYLE WILLIAM YEAGER 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	207P00000X	Emergency Medicine Physician	01076350A	IN

General Provider Information

NPI Number	:	1770926958
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYLE WILLIAM YEAGER M.D.

Provider Business Mailing Address
First Line	:	85 E US HIGHWAY 6
Second Line	:
City	:	VALPARAISO
State	:	IN
Zip	:	46383-8947
Country	:	US
Telephone Number	:	219-983-8300
Fax Number	:

Provider Business Practice Location Address
First Line	:	303 E NICOLLET BLVD STE 160
Second Line	:
City	:	BURNSVILLE
State	:	MN
Zip	:	55337-4588
Country	:	US
Telephone Number	:	952-460-4000
Fax Number	:

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

Provider Enumeration Date	:	04/08/2013
Last Update Date	:	07/11/2019

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