Provider Demographics
NPI:1831343102
Name:KEVIN CREELMAN, MD, PC
Entity type:Organization
Organization Name:KEVIN CREELMAN, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CREELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-486-4183
Mailing Address - Street 1:PO BOX 8103
Mailing Address - Street 2:
Mailing Address - City:KODIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99615-8103
Mailing Address - Country:US
Mailing Address - Phone:907-486-4183
Mailing Address - Fax:907-486-4211
Practice Address - Street 1:104 CENTER AVE
Practice Address - Street 2:STE 100
Practice Address - City:KODIAK
Practice Address - State:AK
Practice Address - Zip Code:99615-6393
Practice Address - Country:US
Practice Address - Phone:907-486-4183
Practice Address - Fax:907-486-4211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-12
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAA1326207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD13262Medicaid
AKK160377Medicare UPIN