Provider Demographics
NPI:1598933491
Name:NOSKOVIAK, KYLE (MD)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:
Last Name:NOSKOVIAK
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 1:4743 E SUGARMAPLE DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65809-2439
Mailing Address - Country:US
Mailing Address - Phone:619-850-6450
Mailing Address - Fax:
Practice Address - Street 1:1000 E PRIMROSE ST STE 550
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-5180
Practice Address - Country:US
Practice Address - Phone:417-269-4647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-13
Last Update Date:2017-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009023903207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology