Provider Demographics
NPI:1609853084
Name:KRICHMAR, PERRY (MD)
Entity Type:Individual
Prefix:DR
First Name:PERRY
Middle Name:
Last Name:KRICHMAR
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 1:1380 S HIATUS ROAD
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33025
Mailing Address - Country:US
Mailing Address - Phone:954-432-1511
Mailing Address - Fax:954-432-5195
Practice Address - Street 1:1380 SOUTH HIATUS ROAD
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33025
Practice Address - Country:US
Practice Address - Phone:954-432-1511
Practice Address - Fax:954-432-5195
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 55521207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL051320200Medicaid
FL051320200Medicaid
FL09408YMedicare PIN