Provider Demographics
NPI:1710092093
Name:CRISTIANO, PETER JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:JOHN
Last Name:CRISTIANO
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 1:720 1ST TER
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:KS
Mailing Address - Zip Code:66043-1704
Mailing Address - Country:US
Mailing Address - Phone:913-682-5588
Mailing Address - Fax:913-682-2698
Practice Address - Street 1:720 1ST TER
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:KS
Practice Address - Zip Code:66043-1704
Practice Address - Country:US
Practice Address - Phone:913-682-5588
Practice Address - Fax:913-682-2698
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-21118207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100203810BMedicaid
KS041818Medicare ID - Type Unspecified
KSD79493Medicare UPIN