Provider Demographics
NPI:1780856716
Name:KRESOVSKY, SETH P (MD)
Entity Type:Individual
Prefix:
First Name:SETH
Middle Name:P
Last Name:KRESOVSKY
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 4699
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47903-4699
Mailing Address - Country:US
Mailing Address - Phone:765-449-2732
Mailing Address - Fax:765-449-1196
Practice Address - Street 1:1345 UNITY PL
Practice Address - Street 2:SUITE 245
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-5770
Practice Address - Country:US
Practice Address - Phone:765-446-5130
Practice Address - Fax:765-446-5131
Is Sole Proprietor?:No
Enumeration Date:2008-03-31
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01064881A207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000586923OtherANTHEM
IN200917460Medicaid
IN200917460Medicaid
INP00674257Medicare PIN