Provider Demographics
NPI:1225498777
Name:COWARD, KYLE
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:COWARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6901 S OGLESBY AVE APT 3B
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60649-1827
Mailing Address - Country:US
Mailing Address - Phone:773-610-0739
Mailing Address - Fax:
Practice Address - Street 1:6901 S OGLESBY AVE APT 3B
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60649-1827
Practice Address - Country:US
Practice Address - Phone:773-610-0739
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-25
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILC630-5017-7015247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other