Provider Demographics
NPI:1457557571
Name:STEWART, KYLE ANDREW (MD)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:ANDREW
Last Name:STEWART
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 1:1200 N PHILLIPS AVE
Mailing Address - Street 2:OUCPB 12400
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-4600
Mailing Address - Country:US
Mailing Address - Phone:405-271-4407
Mailing Address - Fax:405-271-8709
Practice Address - Street 1:1200 N PHILLIPS AVE
Practice Address - Street 2:SUITE 6100
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-4600
Practice Address - Country:US
Practice Address - Phone:405-271-6827
Practice Address - Fax:405-271-4418
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK25710208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics