Provider Demographics
NPI:1326314030
Name:FOWLER, KYLIE GLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:KYLIE
Middle Name:GLEN
Last Name:FOWLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KYLIE
Other - Middle Name:GLEN
Other - Last Name:BOGGESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5901 LINCOLN DRIVE
Mailing Address - Street 2:CBC-2-REV/PE
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55436-1611
Mailing Address - Country:US
Mailing Address - Phone:952-992-5624
Mailing Address - Fax:
Practice Address - Street 1:2525 CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-4518
Practice Address - Country:US
Practice Address - Phone:612-813-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-27
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN63593207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology