Provider Demographics
NPI:1396710646
Name:KADILE, PETER M (DO)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:M
Last Name:KADILE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78100 MAIN ST
Mailing Address - Street 2:STE 207
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92253-8962
Mailing Address - Country:US
Mailing Address - Phone:760-777-7439
Mailing Address - Fax:760-777-1254
Practice Address - Street 1:78100 MAIN ST
Practice Address - Street 2:STE 207
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-8962
Practice Address - Country:US
Practice Address - Phone:760-777-7439
Practice Address - Fax:760-777-1254
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-21
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A6817207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H77955Medicare UPIN
CAZZZ23494ZMedicare ID - Type Unspecified