Provider Demographics
NPI:1558510727
Name:MORRISSEY, KYLE EDWARD (DO)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:EDWARD
Last Name:MORRISSEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 BOYSON RD
Mailing Address - Street 2:
Mailing Address - City:HIAWATHA
Mailing Address - State:IA
Mailing Address - Zip Code:52233-2362
Mailing Address - Country:US
Mailing Address - Phone:319-743-7300
Mailing Address - Fax:
Practice Address - Street 1:1550 BOYSON RD
Practice Address - Street 2:
Practice Address - City:HIAWATHA
Practice Address - State:IA
Practice Address - Zip Code:52233-2362
Practice Address - Country:US
Practice Address - Phone:319-743-7300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-12
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADO-04064207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IADO-04064OtherSTATE LICENSE