Provider Demographics
NPI:1003013673
Name:KRETCHMAN, ERICA MICHELLE (DO)
Entity Type:Individual
Prefix:DR
First Name:ERICA
Middle Name:MICHELLE
Last Name:KRETCHMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MISS
Other - First Name:ERICA
Other - Middle Name:MICHELLE
Other - Last Name:WESTLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1100 REID PKWY
Mailing Address - Street 2:MEDICAL STAFF SERVICES
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-1157
Mailing Address - Country:US
Mailing Address - Phone:765-983-3217
Mailing Address - Fax:765-983-3219
Practice Address - Street 1:1050 REID PKWY
Practice Address - Street 2:SUITE 300
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-1155
Practice Address - Country:US
Practice Address - Phone:765-935-8941
Practice Address - Fax:765-935-8578
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02004002A207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000774723OtherANTHEM BCBS
OH0070092Medicaid
IN201076370Medicaid
INM400074689Medicare PIN