Provider Demographics
NPI:1902832819
Name:KIM, PETER Y (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:Y
Last Name:KIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 S CITRUS AVE STE 302
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34452-4701
Mailing Address - Country:US
Mailing Address - Phone:352-637-0211
Mailing Address - Fax:352-637-5733
Practice Address - Street 1:131 S CITRUS AVE STE 302
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34452-4701
Practice Address - Country:US
Practice Address - Phone:352-637-0211
Practice Address - Fax:352-637-5733
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME91191208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL48524OtherBCBS FL
FL270461700Medicaid
FL48524OtherBCBS FL
FL270461700Medicaid
FL48524TMedicare PIN
FLP00142466Medicare PIN
FL48524WMedicare PIN
FL48524VMedicare PIN
FL48524WMedicare PIN
FL48524YMedicare PIN