Healthcare Provider Details

I. General information

NPI: 1699491951
Provider Name (Legal Business Name): ROXANNE COLLETTE CRAWFORD MEDICAL ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ROXANNE COLLETTE DEBOZY MA

II. Dates (important events)

Enumeration Date: 10/18/2022
Last Update Date: 10/18/2022
Certification Date: 10/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 E EISENHOWER PKWY
ANN ARBOR MI
48108-3231
US

IV. Provider business mailing address

9020 FOWLER RD
HORTON MI
49246-9530
US

V. Phone/Fax

Practice location:
  • Phone: 734-677-0070
  • Fax: 734-428-0408
Mailing address:
  • Phone: 734-645-0942
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: