Provider Demographics
NPI:1083803415
Name:MARCENE F. KREIFELS, M.D., P.A.
Entity Type:Organization
Organization Name:MARCENE F. KREIFELS, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCENE
Authorized Official - Middle Name:F
Authorized Official - Last Name:KREIFELS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-682-1735
Mailing Address - Street 1:1198 S FERDON BLVD
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32536-4512
Mailing Address - Country:US
Mailing Address - Phone:850-682-1735
Mailing Address - Fax:850-689-4400
Practice Address - Street 1:1198 S FERDON BLVD
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32536-4512
Practice Address - Country:US
Practice Address - Phone:850-682-1735
Practice Address - Fax:850-689-4400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-22
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL50036208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDH2506OtherRRB PTAN
FL40933AMedicare PIN
FLD50592Medicare UPIN
FLDH2506OtherRRB PTAN