Healthcare Provider Details

I. General information

NPI: 1447204946
Provider Name (Legal Business Name): DAVID KLYDE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1475 NW 12TH AVE FL 1
MIAMI FL
33136-1002
US

IV. Provider business mailing address

326 CANTERBURY LANE
WYCKOFF NJ
07481
US

V. Phone/Fax

Practice location:
  • Phone: 305-243-1000
  • Fax:
Mailing address:
  • Phone: 973-972-5188
  • Fax: 201-960-3929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number25MA06920200
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberME174397
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: