Provider Demographics
NPI:1558328922
Name:KRYVICKY, JAMES M (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:M
Last Name:KRYVICKY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3601 W 13 MILE RD
Mailing Address - Street 2:ANESTHESIOLOGY DEPT
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073
Mailing Address - Country:US
Mailing Address - Phone:248-723-1635
Mailing Address - Fax:248-723-1681
Practice Address - Street 1:3601 W 13 MILE RD
Practice Address - Street 2:ANESTHESIOLOGY DEPT
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073
Practice Address - Country:US
Practice Address - Phone:248-723-1635
Practice Address - Fax:248-723-1681
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-28
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MI4301027126207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B47687Medicare UPIN