Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 01044047A | IN |
Y | 208600000X | Surgeon | 01044047A | IN |
NPI | 1013907781 |
---|---|
Provider Name | Dr. Robert G. Credi |
First Address | South Bend, IN 46617-2808 |
Second Address | South Bend, IN 46617-2808 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2005 |
Last Update Date | 03/08/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200078980 | (05) | IN |
F57217 | (02) | IN |