Provider Demographics
NPI:1245857101
Name:SCHWICKERATH, KYLE VAN (DPM)
Entity type:Individual
Prefix:DR
First Name:KYLE
Middle Name:VAN
Last Name:SCHWICKERATH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:26900 N LAKE PLEASANT PKWY STE 202
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-1558
Mailing Address - Country:US
Mailing Address - Phone:623-254-7111
Mailing Address - Fax:623-254-7100
Practice Address - Street 1:26900 N LAKE PLEASANT PKWY STE 202
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85383-1558
Practice Address - Country:US
Practice Address - Phone:623-254-7111
Practice Address - Fax:623-254-7100
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-26
Last Update Date:2025-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPOD-001091213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty