Provider Demographics
NPI:1083008874
Name:FARLEY, KYLE CHRISTOPHER (DO)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:CHRISTOPHER
Last Name:FARLEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3946 MILLSBRAE AVE
Mailing Address - Street 2:APT B
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45209-2038
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4860 FRANK AVE NW
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-7426
Practice Address - Country:US
Practice Address - Phone:330-494-7099
Practice Address - Fax:330-494-2147
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-19
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35012518207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty