Individual
DR. ROBERT G. CREDI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
621 MEMORIAL DR STE 502, SOUTH BEND, IN 46601-1075
(574) 647-5875
(574) 647-5878
Mailing address
710 N NILES AVE, SOUTH BEND, IN 46617-1924
(574) 647-1610
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
01044047A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200078980
—
IN
01
—
236040415
MEDICARE PTAN
IN
Enumeration date
10/25/2005
Last updated
06/01/2022
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