Healthcare Provider Details

I. General information

NPI: 1689830564
Provider Name (Legal Business Name): MICHAEL J CRIMMINS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2008
Last Update Date: 07/05/2022
Certification Date: 07/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20900 BISCAYNE BLVD
AVENTURA FL
33180-1407
US

IV. Provider business mailing address

PO BOX 7623
NAPLES FL
34101-7623
US

V. Phone/Fax

Practice location:
  • Phone: 305-682-7000
  • Fax:
Mailing address:
  • Phone: 305-712-7229
  • Fax: 305-397-1139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberME156779
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number265591-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number0101247836
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License NumberME156779
License Number StateFL
# 5
Primary TaxonomyY
Taxonomy Code2084A2900X
TaxonomyNeurocritical Care Physician
License NumberME156779
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: