Provider Demographics
NPI:1164600201
Name:ISTVAN KRISKO, M.D., PH.D., P.A.
Entity Type:Organization
Organization Name:ISTVAN KRISKO, M.D., PH.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LEEANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:PROULX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-746-8446
Mailing Address - Street 1:2055 MILITARY TRL
Mailing Address - Street 2:STE 800
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-7801
Mailing Address - Country:US
Mailing Address - Phone:561-746-8446
Mailing Address - Fax:561-746-8447
Practice Address - Street 1:2055 MILITARY TRL
Practice Address - Street 2:STE 800
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-7801
Practice Address - Country:US
Practice Address - Phone:561-746-8446
Practice Address - Fax:561-746-8447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-31
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME28092207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK0252Medicare PIN