Provider Demographics
NPI:1669686572
Name:CRISWELL, KARA KANE (MD)
Entity type:Individual
Prefix:DR
First Name:KARA
Middle Name:KANE
Last Name:CRISWELL
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 1:14835 BALLANTYNE VILLAGE WAY STE 210
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-4316
Mailing Address - Country:US
Mailing Address - Phone:704-424-5050
Mailing Address - Fax:
Practice Address - Street 1:14835 BALLANTYNE VILLAGE WAY STE 210
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-4316
Practice Address - Country:US
Practice Address - Phone:704-424-5050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-115527208200000X
NC261168690208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery