Provider Demographics
NPI:1528040045
Name:LOY, KYLE D (MD PC)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:D
Last Name:LOY
Suffix:
Gender:M
Credentials:MD PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:SUITE 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
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-18
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01026301A207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100124630BMedicaid
IN000000361234OtherANTHEM PIN
INP00215064OtherMEDICARE RAILROAD
IN100124630BMedicaid
IN228270AMedicare PIN