Provider Demographics
NPI:1841728847
Name:STEWART, KYLE
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:STEWART
Suffix:
Gender:M
Credentials:
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 950293
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0293
Mailing Address - Country:US
Mailing Address - Phone:188-898-7187
Mailing Address - Fax:405-792-8910
Practice Address - Street 1:2307 S HIGHWAY 53
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:KY
Practice Address - Zip Code:40031-8568
Practice Address - Country:US
Practice Address - Phone:150-222-5627
Practice Address - Fax:502-225-6278
Is Sole Proprietor?:No
Enumeration Date:2017-06-02
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY56960208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics