Provider Demographics
NPI:1821058736
Name:ALLEN, KYLE R (DO)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:R
Last Name:ALLEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2424 VALHALLA CT
Mailing Address - Street 2:
Mailing Address - City:XENIA
Mailing Address - State:OH
Mailing Address - Zip Code:45385-8906
Mailing Address - Country:US
Mailing Address - Phone:330-606-1971
Mailing Address - Fax:
Practice Address - Street 1:2424 VALHALLA CT
Practice Address - Street 2:
Practice Address - City:XENIA
Practice Address - State:OH
Practice Address - Zip Code:45385-8906
Practice Address - Country:US
Practice Address - Phone:330-606-1971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102202933207QG0300X
OH34.004461207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1821058736Medicaid
VA1821058736Medicaid
VAP00999263Medicare PIN