Provider Demographics
NPI:1710165915
Name:CRISWELL & CRISWELL, P.A.
Entity Type:Organization
Organization Name:CRISWELL & CRISWELL, P.A.
Other - Org Name:CRISWELL & CRISWELL PLASTIC SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:CRISWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-204-0101
Mailing Address - Street 1:15105 JOHN J DELANEY DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-2847
Mailing Address - Country:US
Mailing Address - Phone:704-424-5050
Mailing Address - Fax:704-424-1020
Practice Address - Street 1:15105 JOHN J DELANEY DR
Practice Address - Street 2:SUITE E
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-2847
Practice Address - Country:US
Practice Address - Phone:704-424-5050
Practice Address - Fax:704-424-1020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-11
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty