MEDICARE: FREDERICK V CRALL JR. 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	35.047194	OH
2	207RC0000X	Cardiovascular Disease Physician	35-04-7194	OH

General Provider Information

NPI Number	:	1457352726
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FREDERICK V CRALL JR. M.D.

Provider Business Mailing Address
First Line	:	PO BOX 1239
Second Line	:
City	:	TROY
State	:	MI
Zip	:	48099-1239
Country	:	US
Telephone Number	:	248-824-6600
Fax Number	:	855-618-6655

Provider Business Practice Location Address
First Line	:	4623 WESLEY AVE
Second Line	:	SUITE P
City	:	CINCINNATI
State	:	OH
Zip	:	45212-2272
Country	:	US
Telephone Number	:	513-841-0777
Fax Number	:	513-841-0877

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

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	03/14/2013

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