Provider Demographics
NPI:1558601997
Name:KRIVENKO, CHARLES ANDREW (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:ANDREW
Last Name:KRIVENKO
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 1:1550 WILTON LN
Mailing Address - Street 2:
Mailing Address - City:SANIBEL
Mailing Address - State:FL
Mailing Address - Zip Code:33957-4223
Mailing Address - Country:US
Mailing Address - Phone:239-395-2949
Mailing Address - Fax:
Practice Address - Street 1:1550 WILTON LN
Practice Address - Street 2:
Practice Address - City:SANIBEL
Practice Address - State:FL
Practice Address - Zip Code:33957-4223
Practice Address - Country:US
Practice Address - Phone:239-395-2949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-21
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME79832207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine