Healthcare Provider Details

I. General information

NPI: 1073709515
Provider Name (Legal Business Name): MICHAEL K. CRIDER, M.D., PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2007
Last Update Date: 09/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3310 W PURDUE AVE
MUNCIE IN
47304-6355
US

IV. Provider business mailing address

3310 W PURDUE AVE
MUNCIE IN
47304-6355
US

V. Phone/Fax

Practice location:
  • Phone: 765-281-1400
  • Fax: 765-282-2133
Mailing address:
  • Phone: 765-281-1400
  • Fax: 765-282-2133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number01029431
License Number StateIN

VIII. Authorized Official

Name: DR. MICHAEL K CRIDER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 765-281-1400