Provider Demographics
NPI:1174637441
Name:JEFFREY T KILAYKO PA
Entity Type:Organization
Organization Name:JEFFREY T KILAYKO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:T
Authorized Official - Last Name:KILAYKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-227-0354
Mailing Address - Street 1:1700 SW 150TH RD
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185-5771
Mailing Address - Country:US
Mailing Address - Phone:305-227-0354
Mailing Address - Fax:
Practice Address - Street 1:1700 SW 150TH RD
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33185-5771
Practice Address - Country:US
Practice Address - Phone:305-227-0354
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2013-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3198642282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1609828938OtherNPI PERSONAL