Provider Demographics
NPI:1982604625
Name:KING, KYLE JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:KYLE
Middle Name:JOSEPH
Last Name:KING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:815 FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:BRANDENBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40108-1415
Mailing Address - Country:US
Mailing Address - Phone:270-422-4111
Mailing Address - Fax:270-422-3629
Practice Address - Street 1:815 FAIRWAY DR
Practice Address - Street 2:
Practice Address - City:BRANDENBURG
Practice Address - State:KY
Practice Address - Zip Code:40108-1415
Practice Address - Country:US
Practice Address - Phone:270-422-4111
Practice Address - Fax:270-422-3629
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY32025207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYKI6432025200Medicaid
KYKI6432025200Medicaid
KY0366102Medicare ID - Type Unspecified