Provider Demographics
NPI:1639155872
Name:KIRCHER, KYLE J (MD)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:J
Last Name:KIRCHER
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 1:6500 UNIVERSITY AVE 100
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50324-1607
Mailing Address - Country:US
Mailing Address - Phone:952-936-6125
Mailing Address - Fax:
Practice Address - Street 1:888 THACKERAY TRL
Practice Address - Street 2:SUITE 103
Practice Address - City:OCONOMOWOC
Practice Address - State:WI
Practice Address - Zip Code:53066-4342
Practice Address - Country:US
Practice Address - Phone:262-354-3744
Practice Address - Fax:262-354-3748
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN38225207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN919514900Medicaid
WI35100200Medicaid
MN080122341OtherRAILROAD MEDICARE
IAENROLLEDMedicaid
MN919514900Medicaid
MN080003988Medicare PIN