Provider Demographics
NPI:1023542487
Name:KEMMERLING, KYLE BRADSHAW (MD)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:BRADSHAW
Last Name:KEMMERLING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4225 E FOWLER AVE STE B
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33617-2026
Mailing Address - Country:US
Mailing Address - Phone:813-972-7100
Mailing Address - Fax:610-271-4245
Practice Address - Street 1:4225 E FOWLER AVE STE B
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33617-2026
Practice Address - Country:US
Practice Address - Phone:813-972-7100
Practice Address - Fax:610-271-4245
Is Sole Proprietor?:No
Enumeration Date:2017-04-12
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME148426207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program