Provider Demographics
NPI:1467947986
Name:FORTE, KYLE ALFRED
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:ALFRED
Last Name:FORTE
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 1:112 WALL ST
Mailing Address - Street 2:
Mailing Address - City:ST SIMONS ISLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31522-5838
Mailing Address - Country:US
Mailing Address - Phone:270-493-2003
Mailing Address - Fax:215-612-4069
Practice Address - Street 1:10800 KNIGHTS RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-4299
Practice Address - Country:US
Practice Address - Phone:215-612-5161
Practice Address - Fax:215-612-4069
Is Sole Proprietor?:No
Enumeration Date:2018-06-27
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA95082207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine