Provider Demographics
NPI:1851685747
Name:MCGIVERN, KYLE V (DO)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:V
Last Name:MCGIVERN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:3130 SW 89TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73159-7909
Mailing Address - Country:US
Mailing Address - Phone:405-455-0155
Mailing Address - Fax:405-737-0221
Practice Address - Street 1:3130 SW 89TH ST STE 200
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73159-7909
Practice Address - Country:US
Practice Address - Phone:405-455-0155
Practice Address - Fax:405-737-0221
Is Sole Proprietor?:No
Enumeration Date:2011-06-08
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK5293207X00000X, 207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK5293OtherMEDICAL LICENSE