Provider Demographics
NPI:1063503100
Name:FUCHS, KYLE IVY (MD)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:IVY
Last Name:FUCHS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KYLE
Other - Middle Name:IVY
Other - Last Name:COHEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1620 N.W. WALMER DRIVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229
Mailing Address - Country:US
Mailing Address - Phone:503-292-1554
Mailing Address - Fax:
Practice Address - Street 1:9427 S.W. BARNES ROAD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-7225
Practice Address - Country:US
Practice Address - Phone:503-571-2727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR12687174400000X
WA00034920174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist