Healthcare Provider Details

I. General information

NPI: 1437151065
Provider Name (Legal Business Name): BRIAN K KRITCHMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 11/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8292 EMERALD AVE
PARKLAND FL
33076-4430
US

IV. Provider business mailing address

8292 EMERALD AVE
PARKLAND FL
33076-4430
US

V. Phone/Fax

Practice location:
  • Phone: 502-552-8581
  • Fax: 561-322-3589
Mailing address:
  • Phone: 502-552-8581
  • Fax: 561-322-3589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME111441
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: