Healthcare Provider Details

I. General information

NPI: 1457670424
Provider Name (Legal Business Name): KAETE ALEXANDRA ARCHER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2010
Last Update Date: 07/16/2024
Certification Date: 07/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9868 FL-7 SUITE 345
BOYNTON BEACH FL
33472
US

IV. Provider business mailing address

640 E MICHIGAN ST APT B430
INDIANAPOLIS IN
46202-0016
US

V. Phone/Fax

Practice location:
  • Phone: 561-737-8584
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number01075043A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number35140196
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number01075043A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberME128043
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: