Provider Demographics
NPI:1629307632
Name:CREATIVE MEDICAL INSTITUTE, LTD.
Entity type:Organization
Organization Name:CREATIVE MEDICAL INSTITUTE, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:FORSYTH
Authorized Official - Last Name:VAN VLEEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-490-9311
Mailing Address - Street 1:5589 GREENWICH RD
Mailing Address - Street 2:175
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-6565
Mailing Address - Country:US
Mailing Address - Phone:757-490-9311
Mailing Address - Fax:757-490-9266
Practice Address - Street 1:5589 GREENWICH RD
Practice Address - Street 2:175
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-6565
Practice Address - Country:US
Practice Address - Phone:757-490-9311
Practice Address - Fax:757-490-9266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-22
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty