MEDICARE: DR. KAILEY LOREN INTROCASO AU.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	231H00000X	Audiologist	AY2593	FL
2	174400000X	Specialist

General Provider Information

NPI Number	:	1568818540
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KAILEY LOREN INTROCASO AU.D.

Provider Business Mailing Address
First Line	:	2900 CORPORATE WAY # D
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33025-3925
Country	:	US
Telephone Number	:	954-276-5685
Fax Number	:	954-985-7074

Provider Business Practice Location Address
First Line	:	1131 N 35TH AVE FL 3
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-5403
Country	:	US
Telephone Number	:	954-265-1616
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/10/2016
Last Update Date	:	03/10/2026

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