Provider Demographics
NPI:1598877649
Name:KRESTOW, VICTOR P (MD)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:P
Last Name:KRESTOW
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 1:7 NW 183RD ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33169-4516
Mailing Address - Country:US
Mailing Address - Phone:305-652-3614
Mailing Address - Fax:305-652-3616
Practice Address - Street 1:7 NW 183RD ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33169-4516
Practice Address - Country:US
Practice Address - Phone:305-652-3614
Practice Address - Fax:305-652-3616
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00098142083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD52259Medicare UPIN