Healthcare Provider Details

I. General information

NPI: 1700828449
Provider Name (Legal Business Name): JOSEPH A CREEVY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 06/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 SMITH RD SUITE L
CINCINNATI OH
45212-2787
US

IV. Provider business mailing address

4700 SMITH RD SUITE L
CINCINNATI OH
45212-2787
US

V. Phone/Fax

Practice location:
  • Phone: 513-366-4000
  • Fax: 513-366-4001
Mailing address:
  • Phone: 513-366-4000
  • Fax: 513-366-4001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number35-03-1750
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: