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NPI Code Detail

MEDICARE: CARLYNN H CREVIER M.D.

MEDICARE: CARLYNN H CREVIER 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
1207R00000XInternal Medicine Physician036-115459IL
2207R00000XInternal Medicine Physician50335WI

General Provider Information

NPI Number : 1962504670
Entity Type Code : Individual
Provider Name (Legal Business Name) : CARLYNN H CREVIER M.D.
Provider Business Mailing Address
First Line : 4328 OLD GREEN BAY RD
Second Line :
City : MOUNT PLEASANT
State : WI
Zip : 53403-9489
Country : US
Telephone Number : 262-687-7606
Fax Number : 262-687-7615
Provider Business Practice Location Address
First Line : 4328 OLD GREEN BAY RD
Second Line :
City : MOUNT PLEASANT
State : WI
Zip : 53403-9489
Country : US
Telephone Number : 262-687-7606
Fax Number : 262-687-7615
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/02/2006
Last Update Date : 10/01/2013

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