Provider Demographics
NPI:1093923468
Name:JUDD, KYLE T (MD)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:T
Last Name:JUDD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:601 ELMWOOD AVE, BOX 665
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642
Mailing Address - Country:US
Mailing Address - Phone:585-276-7790
Mailing Address - Fax:585-276-2497
Practice Address - Street 1:601 ELMWOOD AVE, BOX 665
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642
Practice Address - Country:US
Practice Address - Phone:585-276-7790
Practice Address - Fax:585-276-2497
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN47303207X00000X
TNMD47303207X00000X
SD8302207X00000X
NY278850207XX0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery