Provider Demographics
NPI:1972683688
Name:CRAVENS, EILEEN E (MD)
Entity Type:Individual
Prefix:MRS
First Name:EILEEN
Middle Name:E
Last Name:CRAVENS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 REID PKWY
Mailing Address - Street 2:SUITE 130
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-1155
Mailing Address - Country:US
Mailing Address - Phone:765-983-3208
Mailing Address - Fax:765-983-3207
Practice Address - Street 1:1050 REID PKWY
Practice Address - Street 2:SUITE 130
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-1155
Practice Address - Country:US
Practice Address - Phone:765-983-3208
Practice Address - Fax:765-983-3207
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01032201B207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000143179OtherBLUE CROSS
100826OtherBLACK LUNG
OH0690711Medicaid
110020161OtherRAILROAD MEDICARE
IN100256900AMedicaid
OH0690711Medicaid
100826OtherBLACK LUNG