| Jeffrey Lawrence Crecelius, MD | |
|
721 American Ave Ste 108, Waukesha, WI 53188-5071 | |
| (262) 928-8200 | |
| Not Available |
| Full Name | Jeffrey Lawrence Crecelius |
|---|---|
| Gender | Male |
| Speciality | Neurological Surgery |
| Location | 721 American Ave Ste 108, Waukesha, Wisconsin |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477521573 | NPI | - | NPPES |
| 10824947 | Other | IN | CAQH NUMBER |
| 000000580227 | Other | IN | ANTHEM BLUE CROSS AND BLUE SHIELD |
| 100087570 | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207T00000X | Neurological Surgery | 01036963A (Indiana) | Secondary |
| 207T00000X | Neurological Surgery | 69263-20 (Wisconsin) | Primary |
| Entity Name | Prohealth Medical Group Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1356322440 PECOS PAC ID: 3476465188 Enrollment ID: O20031103000066 |
| Mailing Address | Practice Location Address |
|---|---|
| Jeffrey Lawrence Crecelius, MD 8333 Naab Rd, Suite 250, Indianapolis, IN 46260-5924 Ph: (317) 396-1300 | Jeffrey Lawrence Crecelius, MD 721 American Ave Ste 108, Waukesha, WI 53188-5071 Ph: (262) 928-8200 |
Dr. Christopher King, D.O. Neurological Surgery Medicare: Medicare Enrolled Practice Location: 1111 Delafield St Ste 105, Waukesha, WI 53188 Phone: 262-542-9503 Fax: 262-542-8447 | |
Randy L Gehring, MD Neurological Surgery Medicare: Not Enrolled in Medicare Practice Location: 721 American Ave Ste 108, Waukesha, WI 53188 Phone: 262-928-8200 |