Provider Demographics
NPI:1750319158
Name:KRIZA, CRAIG G (DPM)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:G
Last Name:KRIZA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ONE MEDICAL CTR BLVD
Mailing Address - Street 2:CCMC POB II STE 324
Mailing Address - City:UPLAND
Mailing Address - State:PA
Mailing Address - Zip Code:19013
Mailing Address - Country:US
Mailing Address - Phone:610-876-0347
Mailing Address - Fax:610-876-3788
Practice Address - Street 1:ONE MEDICAL CTR BLVD
Practice Address - Street 2:CCMC POB II STE 324
Practice Address - City:UPLAND
Practice Address - State:PA
Practice Address - Zip Code:19013
Practice Address - Country:US
Practice Address - Phone:610-876-0347
Practice Address - Fax:610-876-3788
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC00274L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0964160Medicaid
PAKR105454Medicare ID - Type Unspecified
PA4220790009Medicare NSC
PA0964160Medicaid