Provider Demographics
NPI:1255433314
Name:KREISMAN, STEVEN (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:KREISMAN
Suffix:
Gender:M
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 19305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28219-9305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14214 BALLANTYNE LAKE RD
Practice Address - Street 2:STE 100
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-3372
Practice Address - Country:US
Practice Address - Phone:704-667-2650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC26115207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1255433314Medicaid
NC8950289Medicaid
SCN26115Medicaid
NC212390GMedicare PIN
SCN26115Medicaid
NC8950289Medicaid
NC212390CMedicare PIN
NC207991SMedicare PIN
NC212390DMedicare PIN
NC1255433314Medicaid
NC207991YMedicare PIN
NC207991WMedicare PIN
NCNC1196AMedicare PIN
NC207991UMedicare PIN
NC207991RMedicare PIN
NC212390FMedicare PIN
NC207991TMedicare PIN
NCC85003Medicare UPIN
NC207991NMedicare PIN