Provider Demographics
NPI:1891134151
Name:BROWN, KYLE FLETCHER (MD)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:FLETCHER
Last Name:BROWN
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 1:1113 DIXON ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61571-9004
Mailing Address - Country:US
Mailing Address - Phone:309-657-8213
Mailing Address - Fax:
Practice Address - Street 1:OSF SAINT FRANCIS MEDICAL CENTER 530 NE GLEN OAK AVE
Practice Address - Street 2:NORTH BUILDING 2620
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61637-0001
Practice Address - Country:US
Practice Address - Phone:309-655-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-20
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.062906207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine