Provider Demographics
NPI:1053303206
Name:FRIEDMAN, KYLE H (MD)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:H
Last Name:FRIEDMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2408
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78298-2408
Mailing Address - Country:US
Mailing Address - Phone:210-485-1850
Mailing Address - Fax:210-493-9500
Practice Address - Street 1:3551 ROGER BROOKE DR
Practice Address - Street 2:
Practice Address - City:FORT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-4504
Practice Address - Country:US
Practice Address - Phone:210-485-1850
Practice Address - Fax:210-539-9582
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6045207L00000X
NV11390207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100505845Medicaid
NV100535Medicare PIN
NVP00326227Medicare PIN