Provider Demographics
NPI:1033154422
Name:KREITHEN, ANDREA (MD)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:KREITHEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8374 MARKET ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34202-5137
Mailing Address - Country:US
Mailing Address - Phone:941-907-8175
Mailing Address - Fax:941-757-3998
Practice Address - Street 1:7270 KYLE CT
Practice Address - Street 2:
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34240-8435
Practice Address - Country:US
Practice Address - Phone:941-907-8175
Practice Address - Fax:941-757-3998
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-18
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL82699207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0005455OtherCIGNA
FL7595192OtherAETNA
FLP00216340OtherRAIL ROAD MEDICARE
FL01103OtherBCBS
FL163259OtherHEALTHPARTNERS
FL5996428OtherGHI
FL0005455OtherCIGNA
FL5996428OtherGHI