Healthcare Provider Details

I. General information

NPI: 1053859124
Provider Name (Legal Business Name): ANDREW MICHAEL DOMINIC CREAN MD MRCP FRCR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2017
Last Update Date: 06/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DIVISION OF CARDIOVASCULAR HEALTH AND 231 ALBERT SABIN WAY
CINCINNATI OH
45267-0001
US

IV. Provider business mailing address

PO BOX 636256 CENTRAL CREDENTIALING
CINCINNATI OH
45263-6256
US

V. Phone/Fax

Practice location:
  • Phone: 513-558-7565
  • Fax:
Mailing address:
  • Phone: 513-245-3104
  • Fax: 513-585-5511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number35.128712
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: