Individual
BRIAN A KRIVISKY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
14551 HOPE CENTER LOOP STE 100, FORT MYERS, FL 33912-4705
(239) 936-2316
(239) 936-3099
Mailing address
3660 BROADWAY, FORT MYERS, FL 33901-8005
(239) 936-2316
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
ME50392
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04140
BCBS
—
05
—
046328100
—
FL
01
—
0624239
AETNA HMO
—
01
—
4129715
AETNA PPO
—
01
—
ME50392
FLORIDA LICENSE
FL
Enumeration date
05/23/2006
Last updated
01/08/2024
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