Provider Demographics
NPI:1912903469
Name:CREELY, JOSEPH J III (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:J
Last Name:CREELY
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4950 NORTON HEALTHCARE BLVD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-2831
Mailing Address - Country:US
Mailing Address - Phone:502-425-5556
Mailing Address - Fax:502-425-5655
Practice Address - Street 1:4950 NORTON HEALTHCARE BLVD
Practice Address - Street 2:SUITE 209
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-2831
Practice Address - Country:US
Practice Address - Phone:502-425-5556
Practice Address - Fax:502-425-5655
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY32074207Y00000X
LA088562207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64320740Medicaid
KY20-4612802OtherTAX ID
KY000000571067OtherBCBS
KYF45430Medicare UPIN
KY000000571067OtherBCBS
KY20-4612802OtherTAX ID