Provider Demographics
NPI:1558855262
Name:ALLAN, KYLE LAMONT (DO)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:LAMONT
Last Name:ALLAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:10815 RANCH ROAD 2222 BLDG 3B
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78730-1159
Mailing Address - Country:US
Mailing Address - Phone:512-614-3300
Mailing Address - Fax:512-372-1665
Practice Address - Street 1:10815 RANCH ROAD 2222 BLDG 3B
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78730-1159
Practice Address - Country:US
Practice Address - Phone:512-614-3300
Practice Address - Fax:512-372-1665
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-15
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101025191208D00000X
MI5101024167204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Single Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX743010975OtherCENTER FOR HEALING AND REGENERATIVE MEDICINE