Provider Demographics
NPI:1144740234
Name:BRAY, KYLE AARON (DPM)
Entity type:Individual
Prefix:DR
First Name:KYLE
Middle Name:AARON
Last Name:BRAY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2880 PLYMOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116-3209
Mailing Address - Country:US
Mailing Address - Phone:440-333-5888
Mailing Address - Fax:
Practice Address - Street 1:2880 PLYMOUTH AVE
Practice Address - Street 2:
Practice Address - City:ROCKY RIVER
Practice Address - State:OH
Practice Address - Zip Code:44116-3209
Practice Address - Country:US
Practice Address - Phone:440-333-5888
Practice Address - Fax:440-333-6766
Is Sole Proprietor?:No
Enumeration Date:2017-06-21
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36.003979213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0409922Medicaid