Organization
KYLE CARE PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KYLE PETERSEN D.O. (PRESIDENT)
(954) 218-4332
Entity
Organization
Contact information
Practice address
3157 N UNIVERSITY DR STE 101, HOLLYWOOD, FL 33024-2258
(754) 206-8250
(754) 206-8260
Mailing address
3157 N UNIVERSITY DR STE 101, HOLLYWOOD, FL 33024-2258
(754) 206-8250
(754) 206-8260
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
OS 11815
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006391800
—
FL
Enumeration date
11/15/2012
Last updated
02/20/2020
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