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JEFFREY LAWRENCE CRECELIUS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
721 AMERICAN AVE STE 108, WAUKESHA, WI 53188-5071
(262) 928-8200
Mailing address
8333 NAAB RD, SUITE 250, INDIANAPOLIS, IN 46260-5924
(317) 396-1300
(317) 396-1346

Taxonomy

Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
01036963A
IN
207T00000X
Neurological Surgery Physician
Primary
69263-20
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000580227
ANTHEM BLUE CROSS AND BLUE SHIELD
IN
05
100087570
IN
01
10824947
CAQH NUMBER
IN
Enumeration date
03/14/2006
Last updated
03/31/2022
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