Individual
DR. CHAD BLAISE KRILICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
401 BICENTENNIAL WAY, SANTA ROSA, CA 95403-2149
(253) 677-1625
Mailing address
5656 EASTLAKE DR, SANTA ROSA, CA 95409-3075
(253) 677-1625
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD00042765
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8389223
—
WA
Enumeration date
08/01/2006
Last updated
05/11/2023
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