Provider Demographics
NPI:1104031053
Name:MANNION, KYLE (MD)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:
Last Name:MANNION
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3841 GREEN HILLS VILLAGE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-2691
Mailing Address - Country:US
Mailing Address - Phone:615-936-2000
Mailing Address - Fax:615-936-2887
Practice Address - Street 1:MEDICAL CENTER EAST SOUTH TOWER
Practice Address - Street 2:1215 21ST AVENUE SOUTH, SUITE 7209
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37232-8605
Practice Address - Country:US
Practice Address - Phone:615-322-6180
Practice Address - Fax:615-936-2887
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA236177207Y00000X
TNMD42138207YP0228X
TNMD0000042138207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric Otolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2157870Medicaid
MA2157870Medicaid