Provider Demographics
NPI:1104289644
Name:ELDREDGE, KYLE STEVEN (DO)
Entity type:Individual
Prefix:DR
First Name:KYLE
Middle Name:STEVEN
Last Name:ELDREDGE
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 1:1447 MEDICAL PARK BLVD STE 407
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-3183
Mailing Address - Country:US
Mailing Address - Phone:904-540-1770
Mailing Address - Fax:
Practice Address - Street 1:1447 MEDICAL PARK BLVD STE 407
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-3183
Practice Address - Country:US
Practice Address - Phone:561-333-1335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-01
Last Update Date:2022-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA89362208600000X
FLOS18566208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery