Provider Demographics
NPI:1427277557
Name:JOSHUA C KREITHEN MD PA
Entity type:Organization
Organization Name:JOSHUA C KREITHEN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:C
Authorized Official - Last Name:KREITHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-907-8174
Mailing Address - Street 1:6310 HEALTH PARKWAY
Mailing Address - Street 2:SUITE 110
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34202-5177
Mailing Address - Country:US
Mailing Address - Phone:941-907-8174
Mailing Address - Fax:941-907-8177
Practice Address - Street 1:6310 HEALTH PARKWAY
Practice Address - Street 2:SUITE 110
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34202-5177
Practice Address - Country:US
Practice Address - Phone:941-907-8174
Practice Address - Fax:941-907-8177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME89315174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDD4440OtherRAIL ROAD MEDICARE
FLK5916Medicare PIN