Provider Demographics
NPI:1245857101
Name:SCHWICKERATH, KYLE VAN (DPM)
Entity type:Individual
Prefix:DR
First Name:KYLE
Middle Name:VAN
Last Name:SCHWICKERATH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10568 W EL CORTEZ PL
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-9674
Mailing Address - Country:US
Mailing Address - Phone:602-502-1425
Mailing Address - Fax:
Practice Address - Street 1:7699 E PINNACLE PEAK RD STE 115
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-6322
Practice Address - Country:US
Practice Address - Phone:602-502-1425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-26
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY262792213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery