Provider Demographics
NPI:1356584106
Name:KYLE, MICHAEL DANIEL (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DANIEL
Last Name:KYLE
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:PO BOX 1000
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-0071
Mailing Address - Country:US
Mailing Address - Phone:541-770-4559
Mailing Address - Fax:
Practice Address - Street 1:1032 E JACKSON ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-7027
Practice Address - Country:US
Practice Address - Phone:541-770-4559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-09
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA41862207ZP0102X
CAA115581207ZP0102X
ORMD171633207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology