Provider Demographics
NPI:1902823941
Name:CROFOOT, KYLE M (MD)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:M
Last Name:CROFOOT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1801 LEE RD STE 165
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-2127
Mailing Address - Country:US
Mailing Address - Phone:407-975-0406
Mailing Address - Fax:407-975-0407
Practice Address - Street 1:601 E ROLLINS ST
Practice Address - Street 2:FLORIDA HOSPITAL OB SPECIALISTS
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-1248
Practice Address - Country:US
Practice Address - Phone:407-975-0406
Practice Address - Fax:407-975-0407
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2016-01-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME43757207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL30784Medicare PIN
FLD54125Medicare UPIN