MEDICARE: DR. DAVID CRITTENDEN MD M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	DC062834	MI
2	208000000X	Pediatrics Physician	DC062834	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DC062834	OTHER	MI	STATE LICENSE NUMBER

General Provider Information

NPI Number	:	1437261815
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID CRITTENDEN MD M.D.

Provider Business Mailing Address
First Line	:	11604 BALDWIN RD
Second Line	:
City	:	GREENVILLE
State	:	MI
Zip	:	48838
Country	:	US
Telephone Number	:	616-894-6290
Fax Number	:	616-225-8967

Provider Business Practice Location Address
First Line	:	123 E CASS ST
Second Line	:
City	:	GREENVILLE
State	:	MI
Zip	:	48838-1905
Country	:	US
Telephone Number	:	616-225-8707
Fax Number	:	616-225-8967

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	08/05/2008

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