Provider Demographics
NPI:1528772860
Name:IKNA KRYSIAK DO LLC
Entity type:Organization
Organization Name:IKNA KRYSIAK DO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IKNA
Authorized Official - Middle Name:
Authorized Official - Last Name:KRYSIAK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:312-860-8447
Mailing Address - Street 1:3001 NW 49TH AVE STE 303
Mailing Address - Street 2:
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33313-7263
Mailing Address - Country:US
Mailing Address - Phone:954-714-0684
Mailing Address - Fax:954-714-4993
Practice Address - Street 1:3001 NW 49TH AVE STE 303
Practice Address - Street 2:
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33313-7263
Practice Address - Country:US
Practice Address - Phone:954-714-0684
Practice Address - Fax:954-714-4993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-11
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty