Individual
GUY G CREVECOEUR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
11141 PARKVIEW PLAZA DR STE 300, FORT WAYNE, IN 46845-1715
(260) 490-7111
(260) 490-2286
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
01065385A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01580914
—
NY
05
—
200901990
—
IN
Enumeration date
08/02/2005
Last updated
10/20/2022
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