Individual
KYLE PETTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
036159935
IL
207L00000X
Anesthesiology Physician
125.072135
IL
Other
Enumeration date
06/18/2018
Last updated
12/28/2022
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