MEDICARE: KYLE CARE PA

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	208D00000X	General Practice Physician	OS 11815	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821332800
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KYLE CARE PA

Provider Business Mailing Address
First Line	:	3157 N UNIVERSITY DR STE 101
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33024-2258
Country	:	US
Telephone Number	:	754-206-8250
Fax Number	:	754-206-8260

Provider Business Practice Location Address
First Line	:	3157 N UNIVERSITY DR STE 101
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33024-2258
Country	:	US
Telephone Number	:	754-206-8250
Fax Number	:	754-206-8260

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. KYLE PETERSEN
Credential	:	D.O.
Telephone Number	:	954-218-4332

Provider Enumeration Date	:	11/15/2012
Last Update Date	:	02/20/2020

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Directions to “KYLE CARE PA ” Practice Location

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