Provider Demographics
NPI:1821653155
Name:SMITH, KYLE MCKRAY (DPM)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:MCKRAY
Last Name:SMITH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4235 SECOR RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-4231
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4235 SECOR RD
Practice Address - Street 2:BLDG 3, FLR 1
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-4299
Practice Address - Country:US
Practice Address - Phone:419-479-5757
Practice Address - Fax:419-479-5760
Is Sole Proprietor?:No
Enumeration Date:2019-05-02
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36.004070213ES0103X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0495170Medicaid