Individual
THERESA R. CRUTHIRD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
121 S SAINT LOUIS BLVD, SOUTH BEND, IN 46617-2924
(574) 233-3123
(574) 233-3125
Mailing address
PO BOX 4016, SOUTH BEND, IN 46634-4016
(574) 233-3123
(574) 233-3125
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
01073502A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201228320
—
IN
Enumeration date
04/05/2010
Last updated
11/26/2014
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