Provider Demographics
NPI:1780615617
Name:KURTZ, LYLE DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:LYLE
Middle Name:DAVID
Last Name:KURTZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8920 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 323
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-2007
Mailing Address - Country:US
Mailing Address - Phone:310-855-1551
Mailing Address - Fax:310-659-8773
Practice Address - Street 1:8920 WILSHIRE BLVD
Practice Address - Street 2:SUITE 323
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2007
Practice Address - Country:US
Practice Address - Phone:310-855-1551
Practice Address - Fax:310-659-8773
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG66758207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF23229Medicare UPIN
CAG66758AMedicare ID - Type Unspecified