Individual
TED J. CRISMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
401 S BROAD ST, STE. B, FREMONT, IN 46737-2114
(260) 495-9803
(260) 495-1238
Mailing address
6920 POINTE INVERNESS WAY STE 200, MEDPARTNERS, ATTN: MEGAN FORTNEY, FORT WAYNE, IN 46804-7934
(260) 479-3515
(260) 479-3520
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01030303A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000329797
ANTHEM BCBS OF INDIANA
IN
05
—
100225590
—
IN
05
—
3117175
—
OH
01
—
4048082
AETNA
—
Enumeration date
08/19/2006
Last updated
01/17/2017
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