Provider Demographics
NPI:1932297934
Name:MCCAUSLAND, KYLE E (MD)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:E
Last Name:MCCAUSLAND
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 1:90 JACKSON PIKE
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631
Mailing Address - Country:US
Mailing Address - Phone:740-446-5002
Mailing Address - Fax:740-446-5761
Practice Address - Street 1:90 JACKSON PIKE
Practice Address - Street 2:
Practice Address - City:GALLIPOLIS
Practice Address - State:OH
Practice Address - Zip Code:45631-1560
Practice Address - Country:US
Practice Address - Phone:740-446-5201
Practice Address - Fax:740-446-5761
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA029917207P00000X
OH35.090863207P00000X
WV23000207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2910532Medicaid
WV3810014212Medicaid
GA000414103JMedicaid
OH2910532Medicaid
WV3810014212Medicaid
OH4285812Medicare PIN