Provider Demographics
NPI:1174562508
Name:KRISS, VESNA MARTICH (MD)
Entity type:Individual
Prefix:
First Name:VESNA
Middle Name:MARTICH
Last Name:KRISS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-272-5134
Mailing Address - Fax:502-272-5339
Practice Address - Street 1:231 E CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1821
Practice Address - Country:US
Practice Address - Phone:502-629-7661
Practice Address - Fax:502-629-5309
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY295322085R0202X, 2085P0229X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY00533119OtherMEDICARE- KENTUCKY CHILDREN'S RADIOLOGISTS
KY000023035WOtherHUMANA- KENTUCKY CHILDREN'S RADIOLOGISTS
KY041762OtherSIHO- KENTUCKY CHILDREN'S RADIOLOGISTS
KY200081580OtherMEDICAID INDIANA- KENTUCKY CHILDREN'S RADIOLOGISTS
KY200081580OtherHEALTHY INDIANA PLAN- KENTUCKY CHILDREN'S RADIOLOGISTS
KY50024320OtherPASSPORT- KENTUCKY CHILDREN'S RADIOLOGISTS
KY200081580OtherANTHEM INDIANA MEDICAID- KENTUCKY CHILDREN'S RADIOLOGISTS
KY200081580OtherMANAGED HEALTH SERVICES- KENTUCKY CHILDREN'S RADIOLOGISTS
KY3721242000OtherPASSPORT ADVANTAGE- KENTUCKY CHILDREN'S RADIOLOGISTS
KY64295322Medicaid
KY000000607176OtherANTHEM- KENTUCKY CHILDREN'S RADIOLOGISTS
KY200081580OtherMD WISE- KENTUCKY CHILDREN'S RADIOLOGISTS
IN20081580OtherMEDICAID INDIANA- KENTUCKY CHILDREN'S RADIOLOGISTS
KY200081580OtherANTHEM INDIANA MEDICAID- KENTUCKY CHILDREN'S RADIOLOGISTS
KY041762OtherSIHO- KENTUCKY CHILDREN'S RADIOLOGISTS