Provider Demographics
NPI:1477831527
Name:MCCLINTOCK, KYLE R (DO)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:R
Last Name:MCCLINTOCK
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:1013 GALLERIA BLVD STE 205
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-1363
Mailing Address - Country:US
Mailing Address - Phone:916-918-2952
Mailing Address - Fax:916-918-2953
Practice Address - Street 1:1013 GALLERIA BLVD STE 205
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-1363
Practice Address - Country:US
Practice Address - Phone:916-918-2952
Practice Address - Fax:916-918-2953
Is Sole Proprietor?:No
Enumeration Date:2011-07-22
Last Update Date:2022-01-12
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Provider Licenses
StateLicense IDTaxonomies
AZ006971207X00000X
MO2011018228207X00000X
CA20A15548207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery