Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 02001636 | IN |
N | 208D00000X | General Practice Physician | 02001636 | IN |
NPI | 1649284688 |
---|---|
Provider Name | Dr. Philip Lloyd Creps |
First Address | Mishawaka, IN 46544-5882 |
Second Address | Mishawaka, IN 46544-5882 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2006 |
Last Update Date | 28/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200045000 | (05) | IN |
G18552 | (02) | IN |