Provider Demographics
NPI:1689677015
Name:KRIKORIAN, ENRIQUE (MD)
Entity Type:Individual
Prefix:
First Name:ENRIQUE
Middle Name:
Last Name:KRIKORIAN
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 1:7100 W 20TH AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-1897
Mailing Address - Country:US
Mailing Address - Phone:305-822-0401
Mailing Address - Fax:305-824-1748
Practice Address - Street 1:7100 W 20TH AVE
Practice Address - Street 2:STE 101
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-1897
Practice Address - Country:US
Practice Address - Phone:305-822-0401
Practice Address - Fax:305-824-1748
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0070117207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL269042OtherAVMED
FL2550972001OtherCIGNA
FLBC BSOther46339
FL2332362OtherAETNA PPO
FL032764OtherNEIGHBORHOOD HEALTH
FL2370834OtherAETNA HMO
FL46339ZMedicare ID - Type Unspecified
FL269042OtherAVMED