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Individual

SETH P KRESOVSKY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1345 UNITY PL, SUITE 245, LAFAYETTE, IN 47905-5770
(765) 446-5130
(765) 446-5131
Mailing address
PO BOX 4699, LAFAYETTE, IN 47903-4699
(765) 449-2732
(765) 449-1196

Taxonomy

Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
01064881A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000586923
ANTHEM
IN
05
200917460
IN
Enumeration date
03/31/2008
Last updated
06/15/2020
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