Provider Demographics
NPI:1982024584
Name:SOCHACKI, KYLE RICHARD (MD)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:RICHARD
Last Name:SOCHACKI
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 1:4605 SAWMILL RD
Mailing Address - Street 2:
Mailing Address - City:UPPER ARLINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43220-2246
Mailing Address - Country:US
Mailing Address - Phone:614-827-8700
Mailing Address - Fax:614-827-8701
Practice Address - Street 1:4605 SAWMILL RD
Practice Address - Street 2:
Practice Address - City:UPPER ARLINGTON
Practice Address - State:OH
Practice Address - Zip Code:43220-2246
Practice Address - Country:US
Practice Address - Phone:614-827-8700
Practice Address - Fax:614-827-8701
Is Sole Proprietor?:No
Enumeration Date:2014-04-22
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.138983207XX0005X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine