DR. KYLE HAVERSTROM DPM NPI 1649791369

NPI Information

NPI: 1649791369
Provider Name: DR. KYLE HAVERSTROM, DPM
Classification: Podiatrist - 213ES0103X
Entity Type: Individual

Specialization: Foot & Ankle Surgery

PECOS Registration: Yes

Address:
11200 SEMINOLE BLVD STE 305
LARGO, FL
ZIP 33778
Phone: (727) 431-9552
Get Directions

DR. Kyle Haverstrom, DPM is a foot and ankle surgery podiatrist in Largo, FL with 7 years of experience. DR. Kyle Haverstrom, DPM NPI is 1649791369. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: BARRY UNIVERSITY SCHOOL OF PODIATRIC MEDICINE
Graduation Year:2017

The provider's business location address is:

11200 SEMINOLE BLVD STE 305
LARGO, FL
ZIP 33778-239
Phone: (727) 431-9552
Fax: (727) 290-4376

The NPI 1649791369 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA).

The following top HCPCS codes were publicly reported for this provider under the Medicare program for the year 2016. The reported codes are based on the top codes for each available Medicare specialty, excluding evaluation and management codes.

X-ray of foot, minimum of 3 views (HCPCS:73630)

The enumeration date for this NPI number is 7/3/2017 and was last updated on 2/19/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	213E00000X	Podiatrist		PO4312	FLORIDA	No
2	213EP1101X	Podiatrist	Primary Podiatric Medicine	PO4312	FLORIDA	No
3	213ES0000X	Podiatrist	Sports Medicine	PO4312	FLORIDA	No
4	213ES0131X	Podiatrist	Foot Surgery	PO4312	FLORIDA	No
5	213ES0103X	Podiatrist	Foot & Ankle Surgery	PO4312	FLORIDA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	14929205	OTHER		CAQH ID
2	5G5CI	OTHER	FLORIDA	BCBS
3	111187000	MEDICAID	FLORIDA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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