Individual
BRYAN K CRISWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
14835 BALLANTYNE VILLAGE WAY STE 210, CHARLOTTE, NC 28277
(704) 424-5050
Mailing address
14835 BALLANTYNE VILLAGE WAY STE 210, CHARLOTTE, NC 28277-4316
(704) 424-5050
(773) 884-8065
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
036115698
IL
208600000X
Surgery Physician
Primary
261168690
NC
2086S0122X
Plastic and Reconstructive Surgery Physician
036115698
IL
Other
Enumeration date
08/14/2006
Last updated
08/16/2019
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