| Kyle Care Pa | |
|
3157 N University Dr Ste 101 Hollywood FL 33024-2258 | |
| (754) 206-8250 | |
| (754) 206-8260 |
| Full Name | Kyle Care Pa |
|---|---|
| Speciality | General Practice |
| Location | 3157 N University Dr Ste 101, Hollywood, Florida |
| Authorized Official Name and Position | Kyle Petersen (PRESIDENT) |
| Authorized Official Contact | 9542184332 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kyle Care Pa 3157 N University Dr Ste 101 Hollywood FL 33024-2258 Ph: (754) 206-8250 | Kyle Care Pa 3157 N University Dr Ste 101 Hollywood FL 33024-2258 Ph: (754) 206-8250 |
| NPI Number | 1821332800 |
|---|---|
| Provider Enumeration Date | 11/15/2012 |
| Last Update Date | 02/20/2020 |
| Medicare PECOS PAC ID | 7012152176 |
|---|---|
| Medicare Enrollment ID | O20130321000179 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821332800 | NPI | - | NPPES |
| 006391800 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | OS 11815 (Florida) | Primary |
| Provider Name | Kyle H Petersen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1790032530 PECOS PAC ID: 8820233984 Enrollment ID: I20130321000211 |
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