# KYLE CARE PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1821332800
- **Authorized official:** DR. KYLE PETERSEN D.O. (PRESIDENT)
- **Authorized official phone:** (954) 218-4332

## Contact information

- **Practice address:** 3157 N UNIVERSITY DR STE 101, HOLLYWOOD, FL 33024-2258
- **Practice address phone:** (754) 206-8250
- **Practice address fax:** (754) 206-8260
- **Mailing address:** 3157 N UNIVERSITY DR STE 101, HOLLYWOOD, FL 33024-2258
- **Mailing address phone:** (754) 206-8250
- **Mailing address fax:** (754) 206-8260

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | OS 11815 | FL | Yes |

## Other

- **Enumeration date:** 11/15/2012
- **Last updated:** 02/20/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 006391800 | — | FL |