Provider Demographics
NPI:1003844085
Name:KREITHEN, JOSHUA C (MD)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:C
Last Name:KREITHEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1S SCHOOL AVE 800
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34237-6045
Mailing Address - Country:US
Mailing Address - Phone:941-365-8679
Mailing Address - Fax:941-365-8680
Practice Address - Street 1:1 S SCHOOL AVE
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34237-6014
Practice Address - Country:US
Practice Address - Phone:941-365-8679
Practice Address - Fax:941-365-8680
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME89315208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL462978OtherAMERIHEALTH
200765427001OtherMEDICAL MUTUAL
FL7604217OtherGHI
FLFL0003764OtherTRICARE CHAMPUS
FL37869OtherBCBS
FLN244654OtherSTAYWELL HEALTHEASE WELLC
FL5604545OtherCIGNA
FL00027098701OtherUNIVERA
FL269798000Medicaid
FL7243539OtherAETNA
FLP00228445OtherRAIL ROAD MEDICARE
FL269798000Medicaid
FL37869ZMedicare PIN