Individual
DR. KYLE RICHARD CARLSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1500 PROVIDENT DR STE B, WARSAW, IN 46580-3297
(260) 484-8551
(260) 482-5060
Mailing address
5052 N CLINTON ST, FORT WAYNE, IN 46825-5822
(260) 408-2203
(260) 408-8014
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
02006490A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300052895
—
IN
Enumeration date
04/28/2015
Last updated
12/10/2024
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