Provider Demographics
NPI:1669409306
Name:KRIVOSHIK, MARK P (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:P
Last Name:KRIVOSHIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1785 NORTHPOINTE PKWY, SUITE 300
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33558
Mailing Address - Country:US
Mailing Address - Phone:813-536-7277
Mailing Address - Fax:833-642-0635
Practice Address - Street 1:1839 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-9089
Practice Address - Country:US
Practice Address - Phone:727-322-1054
Practice Address - Fax:727-322-2725
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME165883207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1576801Medicaid
NJ1576801Medicaid
NJ598680Medicare ID - Type Unspecified