Provider Demographics
NPI:1154623825
Name:KITE, MICHAEL KENNETH (CRNA)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:KENNETH
Last Name:KITE
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 GLENRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:COLD SPRING
Mailing Address - State:KY
Mailing Address - Zip Code:41076-9086
Mailing Address - Country:US
Mailing Address - Phone:513-807-2332
Mailing Address - Fax:
Practice Address - Street 1:20 MEDICAL VILLAGE DR
Practice Address - Street 2:STE 258 INDEPENDENT ANESTHESIOLOGISTS
Practice Address - City:EDGEWOOD
Practice Address - State:KY
Practice Address - Zip Code:41017-5401
Practice Address - Country:US
Practice Address - Phone:859-301-2211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-01
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1112744163W00000X
KY86720367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3123597Medicaid
IN201012210Medicaid
000000691665OtherANTHEM
KY7100146600Medicaid
$$$$$$$$$00OtherBUREAU OF WORKERS COMP
IN201012210Medicaid
KYP00927666Medicare PIN
$$$$$$$$$00OtherBUREAU OF WORKERS COMP
000000691665OtherANTHEM