Provider Demographics
NPI:1023070109
Name:GULESERIAN, KRISTINE JANE (MD)
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:JANE
Last Name:GULESERIAN
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 1:7777 FOREST LN STE B120
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-6906
Mailing Address - Country:US
Mailing Address - Phone:972-566-2525
Mailing Address - Fax:972-566-2032
Practice Address - Street 1:3100 SW 62ND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-3009
Practice Address - Country:US
Practice Address - Phone:305-663-8401
Practice Address - Fax:305-669-6574
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1122208G00000X
FLME129510208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX172724001Medicaid
TX172724001Medicaid
TX8D4989Medicare ID - Type Unspecified