Provider Demographics
NPI:1942795802
Name:MARDEN, KYLE R (MD)
Entity type:Individual
Prefix:DR
First Name:KYLE
Middle Name:R
Last Name:MARDEN
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 1:259 E ERIE ST FL 19
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2987
Mailing Address - Country:US
Mailing Address - Phone:312-695-7950
Mailing Address - Fax:
Practice Address - Street 1:259 E ERIE ST STE 1900
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3246
Practice Address - Country:US
Practice Address - Phone:312-695-7950
Practice Address - Fax:312-695-5747
Is Sole Proprietor?:No
Enumeration Date:2018-06-24
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1609452084S0010X, 2084N0400X
PAMT2306242084N0008X
IL0361740262084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0008XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeuromuscular Medicine
No2084S0010XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySports Medicine
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology