Provider Demographics
NPI:1992842132
Name:ALDEN, KRIS JOHN (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:KRIS
Middle Name:JOHN
Last Name:ALDEN
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7964 SUMMERLIN LAKES DR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1816
Mailing Address - Country:US
Mailing Address - Phone:239-333-1177
Mailing Address - Fax:239-333-1169
Practice Address - Street 1:7964 SUMMERLIN LAKES DR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-1816
Practice Address - Country:US
Practice Address - Phone:239-333-1177
Practice Address - Fax:239-333-1169
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN49647207X00000X
IL036118925207X00000X
FLME140596207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL117021900Medicaid
MN236978000Medicaid
IL036118925Medicaid
IL036118925Medicaid
MN200002635Medicare PIN