Provider Demographics
NPI:1073544094
Name:KYLES, MICHAEL K (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:K
Last Name:KYLES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:PO BOX 860
Mailing Address - Street 2:
Mailing Address - City:SOUTH BOSTON
Mailing Address - State:VA
Mailing Address - Zip Code:24592-0860
Mailing Address - Country:US
Mailing Address - Phone:434-517-3590
Mailing Address - Fax:434-517-3887
Practice Address - Street 1:422 HAMILTON BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH BOSTON
Practice Address - State:VA
Practice Address - Zip Code:24592-5200
Practice Address - Country:US
Practice Address - Phone:434-572-4074
Practice Address - Fax:434-572-4712
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK23806207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1073544094Medicaid