Provider Demographics
NPI:1093802928
Name:KHRIS, MARTA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTA
Middle Name:
Last Name:KHRIS
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 1:4855 W. HILLSBORO BLVD.
Mailing Address - Street 2:SUITE B-2
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073
Mailing Address - Country:US
Mailing Address - Phone:954-418-1683
Mailing Address - Fax:954-418-1698
Practice Address - Street 1:950 GLADES RD STE 4A
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-6401
Practice Address - Country:US
Practice Address - Phone:561-391-8086
Practice Address - Fax:954-354-8151
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0071800207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL21053XMedicare PIN
FLG59973Medicare UPIN