Provider Demographics
NPI:1235188038
Name:CREELMAN, WAYNE LEWIS (MD)
Entity type:Individual
Prefix:
First Name:WAYNE
Middle Name:LEWIS
Last Name:CREELMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 918025
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-8025
Mailing Address - Country:US
Mailing Address - Phone:352-265-7981
Mailing Address - Fax:352-265-7983
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3003
Practice Address - Country:US
Practice Address - Phone:352-265-7981
Practice Address - Fax:352-265-7983
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010737712084P0800X
FLME934082084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4109799Medicaid
FL276092400Medicaid
MI260D176250OtherBC/BS
AC626ZMedicare PIN
MIB86411Medicare UPIN
MI4109799Medicaid