Healthcare Provider Details

I. General information

NPI: 1861692923
Provider Name (Legal Business Name): JEFFREY J CRITCHFIELD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2007
Last Update Date: 09/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3990 JOHN R ST DEPARTMENT OF RADIOLOGY
DETROIT MI
48201
US

IV. Provider business mailing address

4100 JOHN R MAILCODE: HP10ID
DETROIT MI
48201
US

V. Phone/Fax

Practice location:
  • Phone: 313-576-9653
  • Fax: 313-576-9639
Mailing address:
  • Phone: 313-576-9330
  • Fax: 313-576-9639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number4301078280
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number4301078280
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: