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NPI Code Detail

MEDICARE: GUY G CREVECOEUR MD

MEDICARE: GUY G CREVECOEUR MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208200000XPlastic Surgery Physician01065385AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1124029079
Entity Type Code : Individual
Provider Name (Legal Business Name) : GUY G CREVECOEUR MD
Provider Business Mailing Address
First Line : 11109 PARKVIEW PLAZA DR # 117
Second Line :
City : FORT WAYNE
State : IN
Zip : 46845-1701
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 11141 PARKVIEW PLAZA DR STE 300
Second Line :
City : FORT WAYNE
State : IN
Zip : 46845-1715
Country : US
Telephone Number : 260-490-7111
Fax Number : 260-490-2286
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/02/2005
Last Update Date : 10/20/2022

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Directions to “ GUY G CREVECOEUR MD” Practice Location

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