MEDICARE: SUE CRECELIUS M.D.

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
1	2085R0202X	Diagnostic Radiology Physician	32434	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	200159590	OTHER	KY	MANAGED HEALTH SERVICES
6	000000222977	OTHER	KY	ANTHEM BLUE FACET
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265440499
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUE CRECELIUS M.D.

Provider Business Mailing Address
First Line	:	9998 CROSSPOINT BLVD STE 200
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46256-3307
Country	:	US
Telephone Number	:	317-806-8260
Fax Number	:	317-806-8296

Provider Business Practice Location Address
First Line	:	2314 BONNYCASTLE AVE
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40205-1306
Country	:	US
Telephone Number	:	317-579-2150
Fax Number	:	317-806-8260

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	12/30/2024

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