Provider Demographics
NPI:1770758351
Name:KYLE, WILLIAM EDWARD (DO)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:EDWARD
Last Name:KYLE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 OKATIE CENTER BLVD S STE 101
Mailing Address - Street 2:
Mailing Address - City:OKATIE
Mailing Address - State:SC
Mailing Address - Zip Code:29909-7506
Mailing Address - Country:US
Mailing Address - Phone:843-836-3800
Mailing Address - Fax:843-837-7428
Practice Address - Street 1:14 OKATIE CENTER BLVD S
Practice Address - Street 2:SUITE 101
Practice Address - City:OKATIE
Practice Address - State:SC
Practice Address - Zip Code:29909
Practice Address - Country:US
Practice Address - Phone:843-836-3800
Practice Address - Fax:843-837-7428
Is Sole Proprietor?:No
Enumeration Date:2008-04-24
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC36426207R00000X
VA0102203405207R00000X, 208M00000X
TN2096207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP01301190OtherRAILROAD MEDICARE
SC364260Medicaid
SC364260Medicaid
SCP01301190OtherRAILROAD MEDICARE
TN103I113489Medicare PIN