Provider Demographics
NPI:1598707853
Name:KYLE, WILLIAM SHANE (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:SHANE
Last Name:KYLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 629
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:IA
Mailing Address - Zip Code:50009-0629
Mailing Address - Country:US
Mailing Address - Phone:515-645-9911
Mailing Address - Fax:515-967-5581
Practice Address - Street 1:10561 JEFFREYS ST
Practice Address - Street 2:SUITE 100
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4266
Practice Address - Country:US
Practice Address - Phone:702-478-5620
Practice Address - Fax:702-478-5093
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10972207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100506573Medicaid
NVDG738ZMedicare PIN
NV100506573Medicaid
101071Medicare ID - Type Unspecified