| Doctor Name: | MR. KYLE W MULVANA |
| NPI Number: | 1891108163 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | CPO |
| License Number: | CPO02555 |
| Business Practice Address: | 45 River St Chateaugay, NY - 129202003 |
| Business Phone Number: | 5184978007 |
| Business Fax Number: | 5184977009 |
| Mailing Address: | Po Box 236, CHATEAUGAY |
| State: | NY |
| Postal Code: | 129200236 |
| Phone Number: | 5184978007 |
| Fax Number: | 5184977009 |
| NPI Enumeration Date: | 06/04/2014 |
| NPI Last Update Date: | 06/04/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1744P3200X |
| License Number: | CPO02555 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | Prosthetics Case Management |
| Taxonomy Definition: | |