Provider Demographics
NPI:1306357306
Name:KRIZAN, MARTIN PETER (L AC)
Entity Type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:PETER
Last Name:KRIZAN
Suffix:
Gender:M
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 SW 57TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-3922
Mailing Address - Country:US
Mailing Address - Phone:305-265-5265
Mailing Address - Fax:
Practice Address - Street 1:700 SW 57TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-3922
Practice Address - Country:US
Practice Address - Phone:305-265-5265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-17
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3815171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist