Provider Demographics
NPI:1962480178
Name:KROVETZ, L JEROME (MD PHD)
Entity Type:Individual
Prefix:
First Name:L
Middle Name:JEROME
Last Name:KROVETZ
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10151 ENTERPRISE CENTER BOULEVARD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-3760
Mailing Address - Country:US
Mailing Address - Phone:561-416-2144
Mailing Address - Fax:561-416-1372
Practice Address - Street 1:951 NW 13TH ST
Practice Address - Street 2:BLDG 1E
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-2337
Practice Address - Country:US
Practice Address - Phone:561-416-2144
Practice Address - Fax:561-416-1372
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-06
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME100882080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL040134000Medicaid
93707OtherBC
89993OtherWELL CARE
FL040134000Medicaid