Provider Demographics
NPI:1437151065
Name:KRITCHMAN, BRIAN K (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:K
Last Name:KRITCHMAN
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 1:8292 EMERALD AVE
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33076-4430
Mailing Address - Country:US
Mailing Address - Phone:502-552-8581
Mailing Address - Fax:561-322-3589
Practice Address - Street 1:8292 EMERALD AVE
Practice Address - Street 2:
Practice Address - City:PARKLAND
Practice Address - State:FL
Practice Address - Zip Code:33076-4430
Practice Address - Country:US
Practice Address - Phone:502-552-8581
Practice Address - Fax:561-322-3589
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-12
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME111441207W00000X, 207W00000X
IN01036979A207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
4072023OtherAETNA
917287OtherBLOCK VISION
0800011OtherUNITED HEALTHCARE
917287OtherBLOCK VISION
KY1052081Medicaid
000000042389OtherANTHEM KENTUCKY
000000062214OtherANTHEM INDIANA
917287OtherBLOCK VISION
E12356Medicare UPIN
KY180040258OtherMEDICARE RAILROAD KY
IN411360BMedicare PIN
100259780AOtherMEDICAID IN MADISON OFFIC
100259780BOtherMEDICAID IN LOUISVILLE OF
K001342OtherTRICARE KENTUCKY OFFICE
IN180019056OtherMEDICARE RAILROAD IN
1005632OtherTRICARE INDIANA OFFICE