Healthcare Provider Details

I. General information

NPI: 1962480178
Provider Name (Legal Business Name): L JEROME KROVETZ MD PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 08/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

951 NW 13TH ST BLDG 1E
BOCA RATON FL
33486-2337
US

IV. Provider business mailing address

10151 ENTERPRISE CENTER BOULEVARD SUITE 101
BOYNTON BEACH FL
33437-3760
US

V. Phone/Fax

Practice location:
  • Phone: 561-416-2144
  • Fax: 561-416-1372
Mailing address:
  • Phone: 561-416-2144
  • Fax: 561-416-1372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberME10088
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: