Provider Demographics
NPI:1952502395
Name:NELMAN, KYLE RYAN (MD)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:RYAN
Last Name:NELMAN
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 1:2007 STATE ROUTE 59
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-7610
Mailing Address - Country:US
Mailing Address - Phone:330-673-6299
Mailing Address - Fax:330-673-6399
Practice Address - Street 1:2007 STATE ROUTE 59
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240-7610
Practice Address - Country:US
Practice Address - Phone:330-673-6299
Practice Address - Fax:330-673-6399
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA111201207XX0005X
OH35.092675207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0051024Medicaid
OHH002020Medicare PIN