Healthcare Provider Details

I. General information

NPI: 1740749613
Provider Name (Legal Business Name): KYLE PETERS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2019
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9250 N 3RD ST STE 2000
PHOENIX AZ
85020-2403
US

IV. Provider business mailing address

9250 N 3RD ST STE 2000
PHOENIX AZ
85020-2403
US

V. Phone/Fax

Practice location:
  • Phone: 602-861-1168
  • Fax:
Mailing address:
  • Phone: 602-861-1168
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number80975
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: