Provider Demographics
NPI:1679571764
Name:MILLER, KYLE S (DPM)
Entity type:Individual
Prefix:DR
First Name:KYLE
Middle Name:S
Last Name:MILLER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:31015 KEENELAND DR
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS RANCH
Mailing Address - State:TX
Mailing Address - Zip Code:78015-4247
Mailing Address - Country:US
Mailing Address - Phone:830-249-5858
Mailing Address - Fax:830-755-8755
Practice Address - Street 1:109 FALLS CT
Practice Address - Street 2:SUITE 400
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-2977
Practice Address - Country:US
Practice Address - Phone:830-249-5858
Practice Address - Fax:830-755-8755
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0649213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4198865OtherAETNA
TX0072GZOtherBC/BS OF TEXAS
TX089559103Medicaid
TX4198865OtherAETNA
TX00218PMedicare ID - Type Unspecified