MEDICARE: CROTEAU HEALTH PRACTICE, INC.

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1336336544
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CROTEAU HEALTH PRACTICE, INC.

Provider Business Mailing Address
First Line	:	810 ORCHARD LN
Second Line	:	SUITE 102
City	:	BEAVERCREEK TOWNSHIP
State	:	OH
Zip	:	45434-7229
Country	:	US
Telephone Number	:	937-320-4428
Fax Number	:	937-320-4408

Provider Business Practice Location Address
First Line	:	810 ORCHARD LN
Second Line	:	SUITE 102
City	:	BEAVERCREEK TOWNSHIP
State	:	OH
Zip	:	45434-7229
Country	:	US
Telephone Number	:	937-320-4428
Fax Number	:	937-320-4408

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SUZANNE THERESE CROTEAU
Credential	:	D.O.
Telephone Number	:	937-320-4428

Provider Enumeration Date	:	10/02/2007
Last Update Date	:	06/13/2014

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