Healthcare Provider Details

I. General information

NPI: 1659364404
Provider Name (Legal Business Name): MICHAEL WILLIAM CROSSMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2005
Last Update Date: 12/04/2020
Certification Date: 12/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

676 STRAWBERRY HILL CT
COVINGTON KY
41017-9647
US

IV. Provider business mailing address

676 STRAWBERRY HILL CT
COVINGTON KY
41017-9647
US

V. Phone/Fax

Practice location:
  • Phone: 513-702-3746
  • Fax:
Mailing address:
  • Phone: 513-702-3746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number34515
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: