Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 07001164A | IN |
Y | 222Z00000X | Podiatrist | 07001164A | IN |
N | 213E00000X | Podiatrist | 5901002608 | MI |
N | 222Z00000X | Podiatrist | 5901002608 | MI |
N | 213ES0131X | Foot Surgery | P76610 | NY |
NPI | 1194064675 |
---|---|
Provider Name | Dr. Kyle Hamblen |
First Address | Indianapolis, IN 46268-1443 |
Second Address | Indianapolis, IN 46268-1443 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/02/2013 |
Last Update Date | 15/09/2015 |