Basic Information
| Provider Information | |||||||||
| NPI: | 1215167119 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FEHLIS | ||||||||
| FirstName: | KYLE | ||||||||
| MiddleName: | H | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 311627 | ||||||||
| Address2: | |||||||||
| City: | NEW BRAUNFELS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 781311627 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8306250305 | ||||||||
| FaxNumber: | 8306252693 | ||||||||
| Practice Location | |||||||||
| Address1: | 774 LANDA ST | ||||||||
| Address2: | |||||||||
| City: | NEW BRAUNFELS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 781306114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8306250305 | ||||||||
| FaxNumber: | 8306252693 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2009 | ||||||||
| LastUpdateDate: | 01/11/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 01/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | BP10034625 | TX | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | N7921 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | P02569420 | 01 | TX | MEDICARE RAILROAD | OTHER | 00R38T | 01 | GROUP MEDICARE | OTHER | 220194901 | 05 | TX | MEDICAID | 1952326993 | 01 | GROUP NPI | OTHER | 1H0127 | 01 | TX | MEDICARE | OTHER | TXB156234 | 01 | MEDICARE PTAN | OTHER | 126961501 | 01 | GROUP MEDICAID | OTHER |