Provider Demographics
NPI:1326571621
Name:SOFFE, KYLIE MEASOM (MD)
Entity Type:Individual
Prefix:
First Name:KYLIE
Middle Name:MEASOM
Last Name:SOFFE
Suffix:
Gender:F
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:OB GYN ADMINISTRATION 30 N 1900 E RM 2B200
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84132-2101
Mailing Address - Country:US
Mailing Address - Phone:801-581-7647
Mailing Address - Fax:
Practice Address - Street 1:OB GYN ADMINISTRATION 30 N 1900 E RM 2B200
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84132-2101
Practice Address - Country:US
Practice Address - Phone:801-581-7647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-04
Last Update Date:2018-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10959199-1205207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology