Provider Demographics
NPI:1023076312
Name:KINMON, KYLE J (DPM)
Entity type:Individual
Prefix:DR
First Name:KYLE
Middle Name:J
Last Name:KINMON
Suffix:
Gender:M
Credentials:DPM
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Mailing Address - Street 1:1601 CLINT MOORE RD
Mailing Address - Street 2:130
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-5714
Mailing Address - Country:US
Mailing Address - Phone:561-995-0229
Mailing Address - Fax:561-989-0775
Practice Address - Street 1:1601 CLINT MOORE RD
Practice Address - Street 2:130
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-2768
Practice Address - Country:US
Practice Address - Phone:561-995-0229
Practice Address - Fax:561-989-0775
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2014-04-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPO3007213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL340310600Medicaid
FL65766YOtherMEDICARE NUMBER
FLU91103Medicare UPIN