Provider Demographics
NPI:1619971967
Name:HEYL, CREIGHTON GREGORY (DO)
Entity Type:Individual
Prefix:DR
First Name:CREIGHTON
Middle Name:GREGORY
Last Name:HEYL
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 1:26971 CHARDON RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44143-1111
Mailing Address - Country:US
Mailing Address - Phone:440-943-2086
Mailing Address - Fax:440-943-5440
Practice Address - Street 1:26971 CHARDON RD
Practice Address - Street 2:
Practice Address - City:RICHMOND HTS
Practice Address - State:OH
Practice Address - Zip Code:44143-1111
Practice Address - Country:US
Practice Address - Phone:440-943-2086
Practice Address - Fax:440-943-5440
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH003096207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH791126347OtherMEDICARE RAILROAD
OH351497OtherWELLCARE
OH000000130736OtherANTHEM
OH213866900OtherOH DEPT OF LABOR
OH0439627Medicaid
OH3413456000027OtherCARESOURCE
OH213866900OtherOH DEPT OF LABOR
OH791126347OtherMEDICARE RAILROAD
OHB96503Medicare UPIN