Haverstrom, Kyle
Haverstrom, Kyle is an individual health care provider with primary practice located at 11200 Seminole Blvd Ste 305 , Largo FL 33778-3239. He recently has 5 registered licenses in different health care specialties including Podiatric Medicine & Surgery Service Providers / Podiatrist, Podiatric Medicine & Surgery Service Providers / Primary Podiatric Medicine, Podiatric Medicine & Surgery Service Providers / Sports Medicine, Podiatric Medicine & Surgery Service Providers / Foot Surgery, Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery. Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery is his primary health care specialty. Haverstrom, Kyle can be contacted via phone (727) 431-9552.Contact Information
Primary practice address
11200 Seminole Blvd Ste 305
Largo FL 33778-3239
Phone: (727) 431-9552
Fax: (727) 290-4376
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Podiatric Medicine & Surgery Service Providers / Podiatrist | 213E00000X | PO4312 | Florida |
| Podiatric Medicine & Surgery Service Providers / Primary Podiatric Medicine | 213EP1101X | PO4312 | Florida |
| Podiatric Medicine & Surgery Service Providers / Sports Medicine | 213ES0000X | PO4312 | Florida |
| Podiatric Medicine & Surgery Service Providers / Foot Surgery | 213ES0131X | PO4312 | Florida |
| Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery | 213ES0103X | PO4312 | Florida |
Profile Details
| NPI number | 1649791369 |
|---|---|
| LBN Legal business name | Haverstrom, Kyle |
| Credentials | Doctor of Podiatric Medicine (DPM) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 3rd, 2017 |
| Last updated | Feb 19th, 2024 - about last year |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1649791369 | NPPES |
| Other | 14929205 | CAQH ID | |
| Other | 5G5CI | CAQH ID | |
| MEDICAID | 111187000 | CAQH ID |
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