Provider Demographics
NPI:1073715355
Name:SUIRE, KYLE M (DO)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:M
Last Name:SUIRE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6210 EAST US HWY 290
Mailing Address - Street 2:STE. 420 - CREDENTIALING
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-1098
Mailing Address - Country:US
Mailing Address - Phone:512-338-3826
Mailing Address - Fax:512-406-6216
Practice Address - Street 1:151 EXCHANGE BLVD STE 500
Practice Address - Street 2:
Practice Address - City:HUTTO
Practice Address - State:TX
Practice Address - Zip Code:78634-5381
Practice Address - Country:US
Practice Address - Phone:512-846-1244
Practice Address - Fax:512-406-7324
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXQ1030207Q00000X
CO44036207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX343318703Medicaid
TXQ1030OtherLICENSE
TX343318701Medicaid
TX343318703Medicaid
TX389668YMN6Medicare PIN