Healthcare Provider Details

I. General information

NPI: 1326218603
Provider Name (Legal Business Name): ERIN ANGELA CRILL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ERIN ANGELA MORAN MD

II. Dates (important events)

Enumeration Date: 03/03/2008
Last Update Date: 04/26/2023
Certification Date: 04/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 GETTLER ST STE 255
DYER IN
46311-2381
US

IV. Provider business mailing address

PO BOX 781076
DETROIT MI
48278-1076
US

V. Phone/Fax

Practice location:
  • Phone: 219-864-2235
  • Fax: 219-365-1398
Mailing address:
  • Phone: 317-528-4800
  • Fax: 317-865-1479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01068271A
License Number StateIN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: