Provider Demographics
NPI:1013914845
Name:CREBO, ALAN RICHARD (MD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:RICHARD
Last Name:CREBO
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 6550
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46904-6550
Mailing Address - Country:US
Mailing Address - Phone:765-453-5696
Mailing Address - Fax:765-455-4323
Practice Address - Street 1:1601 W LINCOLN RD
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-3275
Practice Address - Country:US
Practice Address - Phone:765-453-5696
Practice Address - Fax:765-455-4323
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01027403207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100188240Medicaid
IN452570013Medicare PIN
IN252690AMedicare PIN
INP00439680Medicare PIN
IN364040AMedicare PIN
IN180002195Medicare PIN
IN160450010Medicare PIN
E03742Medicare UPIN