Provider Demographics
NPI:1336336544
Name:CROTEAU HEALTH PRACTICE, INC.
Entity Type:Organization
Organization Name:CROTEAU HEALTH PRACTICE, INC.
Other - Org Name:SUZANNE CROTEAU, D.O.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:THERESE
Authorized Official - Last Name:CROTEAU
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:937-320-4428
Mailing Address - Street 1:810 ORCHARD LN
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BEAVERCREEK TOWNSHIP
Mailing Address - State:OH
Mailing Address - Zip Code:45434-7229
Mailing Address - Country:US
Mailing Address - Phone:937-320-4428
Mailing Address - Fax:937-320-4408
Practice Address - Street 1:810 ORCHARD LN
Practice Address - Street 2:SUITE 102
Practice Address - City:BEAVERCREEK TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:45434-7229
Practice Address - Country:US
Practice Address - Phone:937-320-4428
Practice Address - Fax:937-320-4408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9371061Medicare PIN