MEDICARE: GREGORY S KRIVONYAK M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2083P0500X	Preventive Medicine/Occupational Environmental Medicine Physician	036163835	IL
2	2083P0500X	Preventive Medicine/Occupational Environmental Medicine Physician	2023041829	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770772725
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY S KRIVONYAK M.D.

Provider Business Mailing Address
First Line	:	3601 SW 160TH AVE STE 250
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33027-6314
Country	:	US
Telephone Number	:	954-399-4673
Fax Number	:	352-323-5039

Provider Business Practice Location Address
First Line	:	100 CHESTERFIELD BUSINESS PKWY FL 2
Second Line	:
City	:	CHESTERFIELD
State	:	MO
Zip	:	63005-1271
Country	:	US
Telephone Number	:	954-399-4673
Fax Number	:	352-323-2261

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/16/2007
Last Update Date	:	06/18/2025

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