Provider Demographics
NPI:1437275229
Name:KYLE D LOY MD PC
Entity Type:Organization
Organization Name:KYLE D LOY MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PC
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:DWAIN
Authorized Official - Last Name:LOY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:765-474-4500
Mailing Address - Street 1:2606 VETERANS MEMORIAL PKWY S
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47909-9192
Mailing Address - Country:US
Mailing Address - Phone:765-474-4500
Mailing Address - Fax:765-474-1122
Practice Address - Street 1:2606 VETERANS MEMORIAL PKWY S
Practice Address - Street 2:STE 1
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47909-9192
Practice Address - Country:US
Practice Address - Phone:765-474-4500
Practice Address - Fax:765-474-1122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01026301A207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INDD2208OtherMEDICARE RAILROAD
IN200903820AMedicaid
IN000000361234OtherANTHEM PIN #
IN200903820AMedicaid
IN000000361234OtherANTHEM PIN #