Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 2427 | WV |
NPI | 1033724240 |
---|---|
Provider Name | Kyle Louis Pytlak |
First Address | Glen Dale, WV 26038-1618 |
Second Address | Wheeling, WV 26003-6379 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2020 |
Last Update Date | 14/09/2020 |