Provider Demographics
NPI:1538599733
Name:KRECKMAN, ERIC
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:KRECKMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 QUARTER ST
Mailing Address - Street 2:
Mailing Address - City:GLADWIN
Mailing Address - State:MI
Mailing Address - Zip Code:48624-1941
Mailing Address - Country:US
Mailing Address - Phone:989-246-6471
Mailing Address - Fax:989-246-6423
Practice Address - Street 1:609 QUARTER ST
Practice Address - Street 2:
Practice Address - City:GLADWIN
Practice Address - State:MI
Practice Address - Zip Code:48624-1941
Practice Address - Country:US
Practice Address - Phone:989-246-6471
Practice Address - Fax:989-246-6423
Is Sole Proprietor?:No
Enumeration Date:2013-11-25
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI9999999999363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant