Healthcare Provider Details

I. General information

NPI: 1154073237
Provider Name (Legal Business Name): KYLE PHILIP PIAZZA PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2022
Last Update Date: 01/20/2022
Certification Date: 01/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1995 E OAKLAND PARK BLVD STE 310
FT LAUDERDALE FL
33306-1138
US

IV. Provider business mailing address

1995 E OAKLAND PARK BLVD STE 310
FT LAUDERDALE FL
33306-1138
US

V. Phone/Fax

Practice location:
  • Phone: 954-791-6146
  • Fax:
Mailing address:
  • Phone: 954-791-6146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPAT9115434
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: