Provider Demographics
NPI:1184019416
Name:KRYSZUK, ALEXANDER ANDREW (MD)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:ANDREW
Last Name:KRYSZUK
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 1:4499 MEDICAL DR STE 120
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3777
Mailing Address - Country:US
Mailing Address - Phone:210-575-5462
Mailing Address - Fax:210-510-6365
Practice Address - Street 1:4499 MEDICAL DR STE 120
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3777
Practice Address - Country:US
Practice Address - Phone:210-575-5462
Practice Address - Fax:210-510-6365
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-03
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT88652086S0129X
NY63620390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program