Provider Demographics
NPI:1023049855
Name:CRONEN, PAUL W JR (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:W
Last Name:CRONEN
Suffix:JR
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 3395
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47732-3395
Mailing Address - Country:US
Mailing Address - Phone:812-801-0840
Mailing Address - Fax:812-801-0025
Practice Address - Street 1:1373 E STATE ROAD 62
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:IN
Practice Address - Zip Code:47250-7328
Practice Address - Country:US
Practice Address - Phone:812-801-0840
Practice Address - Fax:812-801-0024
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01031070208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY2435129000OtherPASSPORT ADVANTAGE
IN100148760AMedicaid
4370884OtherAETNA
KY1073896OtherPASSPORT KY MEDICAID
IN410005POtherSIHO
IN000000042210OtherANTHEM BCBS
KY64754906Medicaid
020041436OtherMEDICARE RAILROAD
IN412840CMedicare PIN
KY64754906Medicaid
IN410005POtherSIHO
IN100148760AMedicaid