| Entity Name: | KYLE CARE, PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 02 Oct 2012 (12 years ago) |
| Document Number: | P12000083443 |
| FEI/EIN Number | 46-1106575 |
| Address: | 3157 N University Dr, Hollywood, FL, 33024, US |
| Mail Address: | 3157 N University Dr, Hollywood, FL, 33024, US |
| ZIP code: | 33024 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1821332800 | 2012-11-15 | 2020-02-20 | 3157 N UNIVERSITY DR STE 101, HOLLYWOOD, FL, 330242258, US | 3157 N UNIVERSITY DR STE 101, HOLLYWOOD, FL, 330242258, US | |||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||
| Phone | +1 754-206-8250 |
| Fax | 7542068260 |
Authorized person
| Name | DR. KYLE PETERSEN |
| Role | PRESIDENT |
| Phone | 9542184332 |
Taxonomy
| Taxonomy Code | 208D00000X - General Practice Physician |
| License Number | OS 11815 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 006391800 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| PETERSEN KYLE H | Agent | 3157 N University Dr, Hollywood, FL, 33024 |
| Name | Role | Address |
|---|---|---|
| PETERSEN KYLE | President | 3157 N University Dr, Hollywood, FL, 33024 |
| Name | Role | Address |
|---|---|---|
| PETERSEN KYLE | Secretary | 3157 N University Dr, Hollywood, FL, 33024 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2020-05-05 | 3157 N University Dr, 101, Hollywood, FL 33024 | No data |
| CHANGE OF MAILING ADDRESS | 2020-05-05 | 3157 N University Dr, 101, Hollywood, FL 33024 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2020-05-05 | 3157 N University Dr, 101, Hollywood, FL 33024 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-27 |
| ANNUAL REPORT | 2023-02-08 |
| ANNUAL REPORT | 2022-03-11 |
| ANNUAL REPORT | 2021-03-23 |
| ANNUAL REPORT | 2020-05-05 |
| ANNUAL REPORT | 2019-05-09 |
| ANNUAL REPORT | 2018-02-17 |
| ANNUAL REPORT | 2017-04-14 |
| ANNUAL REPORT | 2016-01-15 |
| ANNUAL REPORT | 2015-03-09 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
