Provider Demographics
NPI:1861727323
Name:KLINGLER, KYLE NATHANIEL (MD)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:NATHANIEL
Last Name:KLINGLER
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 1:1415 PARKVIEW DR
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301
Mailing Address - Country:US
Mailing Address - Phone:208-734-8934
Mailing Address - Fax:208-734-8974
Practice Address - Street 1:1415 PARKVIEW DR.
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-3250
Practice Address - Country:US
Practice Address - Phone:208-734-8934
Practice Address - Fax:208-734-8974
Is Sole Proprietor?:No
Enumeration Date:2009-10-15
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM12126207W00000X
MN53373207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1861727323Medicaid
IDP01213576OtherRAILROAD MEDICARE
IDP01213576OtherRAILROAD MEDICARE
MN180001478Medicare PIN