Active NPI
Kyle D. Patch, DMD
- Dentist
- Effingham, IL
National Provider Identifier
1730669573
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 1001919-15
- Practice address
- 1200 Network Centre Dr Ste 2
Effingham, IL 62401-4637 - Phone
- (217) 540-5100
- NPI assigned
- Aug 21, 2018
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 1001919-15 | WI | Primary |
Addresses
Primary practice location
1200 Network Centre Dr Ste 2
Effingham, IL 62401-4637
Mailing address
1200 Network Centre Dr Ste 2
Effingham, IL 62401-4637
Phone (217) 540-8386
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1001919-15 | WI | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1534809600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1534809600000",
"number": "1730669573",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1200 NETWORK CENTRE DR STE 2",
"city": "EFFINGHAM",
"state": "IL",
"postal_code": "624014637",
"telephone_number": "217-540-8386"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1200 NETWORK CENTRE DR STE 2",
"city": "EFFINGHAM",
"state": "IL",
"postal_code": "624014637",
"telephone_number": "217-540-5100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PATCH",
"first_name": "KYLE",
"middle_name": "D.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-08-21",
"last_updated": "2018-08-21",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "WI",
"license": "1001919-15",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Effingham, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.