Provider Demographics
NPI:1659351989
Name:CREASMAN, CHARLES MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:MICHAEL
Last Name:CREASMAN
Suffix:
Gender:M
Credentials:MD
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 29870
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85038-9870
Mailing Address - Country:US
Mailing Address - Phone:602-772-3805
Mailing Address - Fax:602-772-3801
Practice Address - Street 1:444 W OSBORN RD
Practice Address - Street 2:SUITE 200
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-3814
Practice Address - Country:US
Practice Address - Phone:602-230-1400
Practice Address - Fax:602-230-7676
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ13814207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ3Z3958OtherHEALTHNET
AZ230855Medicaid
AZZ137359Medicare PIN
AZ230855Medicaid