Provider Demographics
NPI:1073697025
Name:SANCHACK, KRISTIAN E (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISTIAN
Middle Name:E
Last Name:SANCHACK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2605 CODY DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-5585
Mailing Address - Country:US
Mailing Address - Phone:425-677-5465
Mailing Address - Fax:
Practice Address - Street 1:NAVAL HOSPITAL JACKSONVILLE
Practice Address - Street 2:2080 CHILDS ST
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32214-0001
Practice Address - Country:US
Practice Address - Phone:425-677-5465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101236109207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine