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General NPI Number Information
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NPI Number | 1669409306
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Entity Type | Individual
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Provider Name | MARK P. KRIVOSHIK MD
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Gender | Male
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Dates
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Enumeration Date | 06/27/2006
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Last Update Date | 04/25/2025
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Provider Practice Location Address
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Address Line | 1839 CENTRAL AVE
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City | ST PETERSBURG
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State | FL
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Zip | 33713-9089
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Country | US
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Telephone | 727-322-1054
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Fax | 727-322-2725
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Provider Business Mailing Address
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Address Line | 1785 NORTHPOINTE PKWY, SUITE 300
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City | CLEARWATER
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State | FL
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Zip | 33558
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Country | US
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Telephone | 813-536-7277
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Fax | 833-642-0635
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME165883
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License Number State | FL
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