Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Kyle Matthew Fredrickson, MD

Individual provider Pediatrics Physician · NPI 1134869696

Kyle Matthew Fredrickson, MD is a Pediatric Medicine in Lakeville, Minnesota. Qualified in 2022, 4 years ago. Works from 2 locations. Licensed in Minnesota and North Carolina.

Years since qualifying
4
Licensed in
MN, NC
In the registry since
2022
Specialties on file
2
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

18484 Kachina Ct
Lakeville, MN 55044-4886
Phone: (952) 993-8800
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • Medical Center Boulevard, Winston Salem, NC 27157-0001 — (336) 716-9252

Specialties & licences

Pediatrics Physician (primary) Taxonomy 208000000X · Licence 82141 (MN)
Pediatrics Physician Taxonomy 208000000X · Licence 2025-02382 (NC)

Record details

NPI number1134869696
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedMarch 31, 2022
Last updated in NPPESMay 12, 2026
Certification dateMay 12, 2026
Mailing address8170 33rd Ave S # Ms 21110q, Bloomington, MN 55425-4516

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPEDIATRIC MEDICINE
Medical schoolOTHER
Graduated 2022 (4 years in practice)
Accepts Medicare assignment Not indicated
Practice locations3 on file with Medicare

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