Provider Demographics
NPI:1679534788
Name:CREANY, TIMOTHY (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:
Last Name:CREANY
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 1:14062 DENVER WEST PKWY BLDG 52
Mailing Address - Street 2:STE 150
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80401-3187
Mailing Address - Country:US
Mailing Address - Phone:303-893-8300
Mailing Address - Fax:303-825-7927
Practice Address - Street 1:14062 DENVER WEST PKWY BLDG 52
Practice Address - Street 2:STE 150
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80401-3187
Practice Address - Country:US
Practice Address - Phone:303-893-8300
Practice Address - Fax:303-825-7927
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO37786225500000X
CODR.0037786207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO51323354Medicaid
CO51323354Medicaid
COG94885Medicare UPIN