Organization Name: | KYLE CARE PA |
NPI Number: | 1821332800 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | KYLE PETERSEN (PRESIDENT) |
Mailing Address: | 8930 W State Road 84 #210 Davie |
State: | FL US |
Postal Code: | 333244456 |
Phone Number: | 9542184332 |
Fax Number: | |
NPI Enumeration Date: | 11/15/2012 |
NPI Last Update Date: | 03/08/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | OS 11815 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |