Provider Demographics
NPI:1508972209
Name:DEETER, KRISTINA (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISTINA
Middle Name:
Last Name:DEETER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1117 E HALLANDALE BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33009
Mailing Address - Country:US
Mailing Address - Phone:954-457-8771
Mailing Address - Fax:954-266-4006
Practice Address - Street 1:3501 JOHNSON ST
Practice Address - Street 2:DIVISION OF PEDIATRIC CRITICAL CARE
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-5421
Practice Address - Country:US
Practice Address - Phone:954-265-6301
Practice Address - Fax:954-985-1434
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000467752080P0203X
FLME1040262080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine