Provider Demographics
NPI:1245326230
Name:KYLE, JULIA (MD)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:KYLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 E CLAIREMONT AVE STE D
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-6480
Mailing Address - Country:US
Mailing Address - Phone:715-828-9060
Mailing Address - Fax:715-514-2467
Practice Address - Street 1:431 E CLAIREMONT AVE STE D
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-6480
Practice Address - Country:US
Practice Address - Phone:715-828-9060
Practice Address - Fax:715-514-2467
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI41220207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32574500Medicaid
WI32574500Medicaid