Provider Demographics
NPI:1215167119
Name:FEHLIS, KYLE H (MD)
Entity type:Individual
Prefix:DR
First Name:KYLE
Middle Name:H
Last Name:FEHLIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 311627
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78131-1627
Mailing Address - Country:US
Mailing Address - Phone:830-625-0305
Mailing Address - Fax:830-625-2693
Practice Address - Street 1:457 LANDA ST STE C
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-5414
Practice Address - Country:US
Practice Address - Phone:830-627-9088
Practice Address - Fax:833-973-1245
Is Sole Proprietor?:No
Enumeration Date:2009-07-26
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10034625207Q00000X
TXN7921207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
00R38TOtherGROUP MEDICARE
1952326993OtherGROUP NPI
TX220194901Medicaid
TX1H0127OtherMEDICARE
126961501OtherGROUP MEDICAID
TXP02569420OtherMEDICARE RAILROAD
TXB156234OtherMEDICARE PTAN