Healthcare Provider Details

I. General information

NPI: 1275609497
Provider Name (Legal Business Name): WILLIAM MICHAEL CRECELIUS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 01/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 CHESTNUT ST
EVANSVILLE IN
47713-1227
US

IV. Provider business mailing address

PO BOX 3868
EVANSVILLE IN
47737-3868
US

V. Phone/Fax

Practice location:
  • Phone: 812-479-6909
  • Fax: 812-858-4548
Mailing address:
  • Phone: 812-479-6909
  • Fax: 812-858-4548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01044976A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: