Provider Demographics
NPI:1861981037
Name:SCHANK, KYLE (MD)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:SCHANK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:701 N 1ST ST PO BOX 19638 SUITE D327
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62781-3489
Mailing Address - Country:US
Mailing Address - Phone:172-545-7762
Mailing Address - Fax:217-545-7762
Practice Address - Street 1:1200 E MICHIGAN AVE STE 655
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-1837
Practice Address - Country:US
Practice Address - Phone:517-364-5388
Practice Address - Fax:517-364-5943
Is Sole Proprietor?:No
Enumeration Date:2018-05-03
Last Update Date:2025-03-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301512390208600000X
IL125081492208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery