DAVID STUART KYLLO (NPI# 1003811464) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1003811464 |
| Entity Type | Individual |
| Full Name | DAVID STUART KYLLO |
| Credential | M.D. |
| Practice Address |
3460 Washington Dr Ste 102 Eagan MN 55122-4301 |
| Practice Telephone | 6514529240 |
| Practice Fax Number | 6514525440 |
| Mailing Telephone | 6514529240 |
| Mailing Fax Number | 6514525440 |
| Enumeration Date | 2005-06-14 |
| Last Update Date | 2007-07-08 |
| NPI Deactivation Date | 03/17/2006 |
| NPI Reactivation Date | 2006-03-22 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 25450 | MN | Allopathic & Osteopathic Physicians |
| Street Address |
3460 WASHINGTON DR STE 102 |
| City | EAGAN |
| State | MN |
| Zip Code | 55122-4301 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942755616 | Amber John | Counselor | 3460 Washington Dr, 110, Eagan, MN 55122-1338 | 2016-08-23 |
| 1891142287 | Stephanie Miller | Counselor | 3460 Washington Dr, Suite 110, Eagan, MN 55122-1338 | 2016-05-16 |
| 1366811382 | Emily Margaret Blom | Marriage & Family Therapist | 3460 Washington Dr, #110, Eagan, MN 55122-1338 | 2015-09-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730651753 | Alvaro Jesus Jimenez Aguilar | Registered Nurse | 1764 Silver Bell Rd, Eagan, MN 55122 | 2019-01-02 |
| 1194213280 | Amherst H. Wilder Foundation | Lodging | Lincoln Place, 1997 Gold Trail, Eagan, MN 55122 | 2018-04-25 |
| 1831541168 | Mackenzie Lea Kerber | Counselor | 3410 Federal Dr Suite 101, Eagan, MN 55122 | 2016-07-11 |
| 1285010074 | Eagan Pointe Senior Living | Assisted Living Facility | 4232 Black Hawk Road, Eagan, MN 55122 | 2015-08-04 |
| 1700268828 | Kara Beth Rose | Specialist/Technologist | 4560 Cinnamon Ridge Trail, Eagan, MN 55122 | 2015-06-25 |
| 1558740803 | Samuel Johnson | Physician Assistant | 2901 Metro Drive, Suite 527, Bloomington, MN 55122 | 2015-05-20 |
| 1528451028 | Judi Ross Holistic Therapy, LLC | Marriage & Family Therapist | 4141 Old Sibley Memorial Highway, Eagan, MN 55122 | 2015-03-09 |
| 1447649637 | Leah Ruth Streitman | Physician Assistant | 3460 Washington Dr Ste 200, Eagan, MN 55122 | 2015-01-12 |
| 1518362193 | Cedar Valley Center for Child & Family Therapy | Preferred Provider Organization | 3460 Washington Dr., Suite 110, Eagan, MN 55122 | 2014-10-25 |
| 1316351703 | Wecare Dental of Eagan P.c | Clinic/Center | 1625 Lena Court Suite 100, Eagan, MN 55122 | 2014-06-13 |
| Find all providers in zip 55122 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811231038 | Steven S Eisenberg | Family Medicine | 3610 Sunwood Trl, Eagan, MN 55123-2417 | 2012-11-15 |
| 1649587403 | John Granville Ward | Family Medicine | 1634 Murphy Pkwy, Home Address No Business Address, Eagan, MN 55122-1753 | 2010-08-31 |
| 1528252764 | Lucas Joel Hammell | Family Medicine | 1654 Diffley Rd Ste 100, Eagan, MN 55122-2237 | 2007-08-30 |
| 1063489540 | Charles E Pogemiller Sr. | Family Medicine | 1215 Town Centre Dr, Eagan, MN 55123-1033 | 2006-03-03 |
| 1972575470 | David J Caccamo | Family Medicine | 930 Blue Gentian Rd Ste 1000, Eagan, MN 55121-1675 | 2006-02-07 |
| 1700858974 | Raina L Young | Family Medicine | 1654 Diffley Rd, Eagan, MN 55122-2237 | 2006-02-02 |
| 1376515536 | Michelle L Knight | Family Medicine | 1654 Diffley Rd Suite 100 - Mail Stop 34701a, Healthpartners Eagan Clinic, Eagan, MN 55122-2237 | 2006-02-02 |
| 1255310298 | Tara L Broadwater | Family Medicine | 3647 Windtree Ct, Eagan, MN 55123-1314 | 2006-01-10 |
| 1992780712 | Leslie Glen Massoglia | Family Medicine | 4845 Safari Ct N, Eagan, MN 55122-2617 | 2005-12-14 |
| 1265416572 | Suzanne F Permuth | Family Medicine | 1885 Plaza Dr, Park Nicollet Clinic Eagan, Eagan, MN 55122-2612 | 2005-11-30 |
| Find all providers in EAGAN | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.