Provider Demographics
NPI:1093195398
Name:CORRELL, KYLE NATHANIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:NATHANIEL
Last Name:CORRELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3775 TIMOTHY LN
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18020-6962
Mailing Address - Country:US
Mailing Address - Phone:484-695-0720
Mailing Address - Fax:
Practice Address - Street 1:201 N CLYDE MORRIS BLVD STE 200
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-2765
Practice Address - Country:US
Practice Address - Phone:386-254-4165
Practice Address - Fax:386-254-4339
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-02
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL21903207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine