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General NPI Number Information
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NPI Number | 1073581724
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Entity Type | Individual
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Provider Name | ANDREW J. CROAK D.O.
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Gender | Male
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Dates
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Enumeration Date | 03/09/2006
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Last Update Date | 05/10/2024
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Provider Practice Location Address
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Address Line | 6005 MONCLOVA RD STE 320
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City | MAUMEE
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State | OH
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Zip | 43537-1862
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Country | US
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Telephone | 419-893-7134
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Fax | 419-893-6942
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Provider Business Mailing Address
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Address Line | 6005 MONCLOVA RD STE 320
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City | MAUMEE
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State | OH
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Zip | 43537-1862
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VF0040X
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Taxonomy Name | Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
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License Number | OH6943C
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | 34006843
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 34006843
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License Number State | OH
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