Blake, Kyle Matthew
Blake, Kyle Matthew is an individual health care provider with primary practice located at 102 Decker Ct Suite 205, Irving TX 75062-2740. He recently has only one registered license in Allopathic & Osteopathic Physicians / Diagnostic Radiology, which is considered as his primary health care specialty. Blake, Kyle Matthew can be contacted via phone (972) 906-6250.Contact Information
Primary practice address
102 Decker Ct Suite 205
Irving TX 75062-2740
Phone: (972) 906-6250
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Diagnostic Radiology | 2085R0202X | Q1362 | Texas |
Profile Details
| NPI number | 1770741977 |
|---|---|
| LBN Legal business name | Blake, Kyle Matthew |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | May 26th, 2008 |
| Last updated | Jan 10th, 2019 - about 7 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1770741977 | NPPES |
| Texas | MEDICAID | 341545705 | |
| Texas | Other | Q1362 |
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