Provider Demographics
NPI:1902851371
Name:KIRIAZIS, CHRISOULA (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISOULA
Middle Name:
Last Name:KIRIAZIS
Suffix:
Gender:F
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:PO BOX 10744
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33757-8744
Mailing Address - Country:US
Mailing Address - Phone:727-532-0002
Mailing Address - Fax:
Practice Address - Street 1:1007 JEFFORDS ST
Practice Address - Street 2:SUITE 101
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-4023
Practice Address - Country:US
Practice Address - Phone:727-442-5123
Practice Address - Fax:813-635-2657
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2011-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME63980207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003621800Medicaid
FL110105219OtherRAILROAD MEDICARE NUMBER
FL18830ZMedicare PIN
FL110105219OtherRAILROAD MEDICARE NUMBER