Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213EP1101X | Primary Podiatric Medicine | 9065045-0501 | UT |
N | 213ES0103X | Foot & Ankle Surgery | 9065045-0501 | UT |
Y | 213ES0103X | Foot & Ankle Surgery | POD-000927 | AZ |
NPI | 1487093746 |
---|---|
Provider Name | Dr. Kyle Cornelius Gillespie |
First Address | Glendale, AZ 85308-8463 |
Second Address | Glendale, AZ 85308-8463 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2013 |
Last Update Date | 18/06/2020 |