Provider Demographics
NPI:1518212026
Name:KYLE, DAVID ALTON (DPM)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ALTON
Last Name:KYLE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1915 BISHOP LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40218-1901
Mailing Address - Country:US
Mailing Address - Phone:502-459-3338
Mailing Address - Fax:502-459-7509
Practice Address - Street 1:1915 BISHOP LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-1901
Practice Address - Country:US
Practice Address - Phone:502-459-3338
Practice Address - Fax:502-459-7509
Is Sole Proprietor?:No
Enumeration Date:2012-07-20
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY00395213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000941140OtherANTHEM
IN201380630Medicaid
KY50092415OtherPASSPORT HEALTH PLAN
KY7100356950Medicaid
KYP01484054OtherRAILROAD MEDICARE
KY000000941140OtherANTHEM