Healthcare Provider Details

I. General information

NPI: 1003844085
Provider Name (Legal Business Name): JOSHUA C KREITHEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 09/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 S SCHOOL AVE
SARASOTA FL
34237-6014
US

IV. Provider business mailing address

1S SCHOOL AVE 800
SARASOTA FL
34237-6045
US

V. Phone/Fax

Practice location:
  • Phone: 941-365-8679
  • Fax: 941-365-8680
Mailing address:
  • Phone: 941-365-8679
  • Fax: 941-365-8680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberME89315
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: