Basic Information
Provider Information
NPI: 1003013673
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KRETCHMAN
FirstName: ERICA
MiddleName: MICHELLE
NamePrefix: DR.
NameSuffix:  
Credential: DO
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: WESTLEY
OtherFirstName: ERICA
OtherMiddleName: MICHELLE
OtherNamePrefix: MISS
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType: 1
Mailing Information
Address1: 1100 REID PKWY
Address2: MEDICAL STAFF SERVICES
City: RICHMOND
State: IN
PostalCode: 473741157
CountryCode: US
TelephoneNumber: 7659833217
FaxNumber: 7659833219
Practice Location
Address1: 1050 REID PKWY
Address2: SUITE 300
City: RICHMOND
State: IN
PostalCode: 473741155
CountryCode: US
TelephoneNumber: 7659358941
FaxNumber: 7659358578
Other Information
ProviderEnumerationDate: 06/28/2007
LastUpdateDate: 03/15/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RE0101X02004002AINY Allopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism

ID Information
IDTypeStateIssuerDescription
00000077472301 ANTHEM BCBSOTHER
20107637005IN MEDICAID
007009205OH MEDICAID


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