Basic Information
| Provider Information | |||||||||
| NPI: | 1417119553 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CRETE | ||||||||
| FirstName: | RYAN | ||||||||
| MiddleName: | NICHOLAS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10700 E GEDDES AVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | ENGLEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801123861 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037619190 | ||||||||
| FaxNumber: | 7208744462 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 ALA MOANA BLVD STE 5B | ||||||||
| Address2: | |||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 96813 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037619190 | ||||||||
| FaxNumber: | 7208744462 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2008 | ||||||||
| LastUpdateDate: | 07/24/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | MD-15289 | HI | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 10025709000 | 05 | NE | MEDICAID | 10026277400 | 05 | NE | MEDICAID | 84089712600 | 05 | NE | MEDICAID | H104995 | 01 | HI | MEDICARE | OTHER | 627576AE6Y | 01 | CO | MEDICARE | OTHER | 627576YQ33 | 01 | CO | MEDICARE | OTHER | 627576YQN9 | 01 | CO | MEDICARE | OTHER | NA1215128 | 01 | NE | MEDICARE | OTHER | 627576ZLJ3 | 01 | CO | MEDICARE | OTHER | KA3249105 | 01 | KS | MEDICARE | OTHER | 10026277300 | 05 | NE | MEDICAID | 10026277500 | 05 | NE | MEDICAID | 627576YQPG | 01 | CO | MEDICARE | OTHER | 627576ZNTB | 01 | CO | MEDICARE | OTHER | H104776 | 01 | HI | MEDICARE | OTHER | 111257114 | 01 | KS | MEDICARE | OTHER | 9000156797 | 05 | CO | MEDICAID | 10026277600 | 05 | NE | MEDICAID | 10026277700 | 05 | NE | MEDICAID | 84059792913 | 05 | NE | MEDICAID | H111054 | 01 | HI | MEDICARE | OTHER | NA1214127 | 01 | NE | MEDICARE | OTHER | NA2517105 | 01 | NE | MEDICARE | OTHER | 10026277800 | 05 | NE | MEDICAID |