Provider Demographics
NPI:1710081732
Name:WEAR, KYLE J
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:J
Last Name:WEAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6750 MORNINGSIDE DR
Mailing Address - Street 2:
Mailing Address - City:VALLEY VIEW
Mailing Address - State:OH
Mailing Address - Zip Code:44125-5567
Mailing Address - Country:US
Mailing Address - Phone:216-901-0296
Mailing Address - Fax:
Practice Address - Street 1:55 W WATERLOO RD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44319-1116
Practice Address - Country:US
Practice Address - Phone:330-724-7715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH63224207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHF28778Medicare UPIN