Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 0001299 | CO |
Y | 213ES0000X | Sports Medicine | 0001299 | CO |
NPI | 1154950814 |
---|---|
Provider Name | Mr. Kyle S Kahl |
First Address | Boulder, CO 80303-1377 |
Second Address | Boulder, CO 80303-1377 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2020 |
Last Update Date | 05/04/2020 |