Provider Demographics
NPI:1487843520
Name:GREENE, KRISTIE A (MD)
Entity Type:Individual
Prefix:
First Name:KRISTIE
Middle Name:A
Last Name:GREENE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2410 NORTHSIDE DR
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-2236
Mailing Address - Country:US
Mailing Address - Phone:274-990-3517
Mailing Address - Fax:727-787-3312
Practice Address - Street 1:1900 S TUTTLE AVE
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-3114
Practice Address - Country:US
Practice Address - Phone:941-799-5753
Practice Address - Fax:888-814-0877
Is Sole Proprietor?:No
Enumeration Date:2007-10-15
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME106607207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLGRZ0DOtherBLUE CROSS AND BLUE SHIELD
FL018894600Medicaid
FLIT663ZMedicare PIN