Provider Demographics
NPI:1578616090
Name:STANOSHECK, KYLE DOUGLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:DOUGLAS
Last Name:STANOSHECK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 840853
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-0865
Mailing Address - Country:US
Mailing Address - Phone:972-715-5000
Mailing Address - Fax:972-715-9976
Practice Address - Street 1:600 S TYLER ST STE 2100
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79101-2304
Practice Address - Country:US
Practice Address - Phone:972-715-5000
Practice Address - Fax:972-715-9976
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8202207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX168015902Medicaid
TX8AW238OtherBLUE CROSS BLUE SHIELD
TX8K7237OtherBLUE CROSS
TX168015901Medicaid
TX8C2366Medicare PIN
TX8AW238OtherBLUE CROSS BLUE SHIELD
TX168015901Medicaid
8K6854Medicare PIN