Provider Demographics
NPI:1609854520
Name:CRONEN, MICHAEL C (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:C
Last Name:CRONEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 26798
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-2018
Mailing Address - Country:US
Mailing Address - Phone:888-488-8289
Mailing Address - Fax:502-919-9780
Practice Address - Street 1:252 WHITTINGTON PARKWAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-4904
Practice Address - Country:US
Practice Address - Phone:502-423-7246
Practice Address - Fax:502-292-5755
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02001309A207LP2900X
KY02267207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100024340Medicaid
KY64022676Medicaid
IN100024340Medicaid
CA4891Medicare PIN
KY1529601Medicare PIN
IN412360Medicare PIN