Healthcare Provider Details

I. General information

NPI: 1427874403
Provider Name (Legal Business Name): MARGARET CRAW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2024
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3953 24TH AVE
FORT GRATIOT MI
48059-4193
US

IV. Provider business mailing address

3664 WOODGATE DR
SAINT JOSEPH MI
49085-8223
US

V. Phone/Fax

Practice location:
  • Phone: 810-363-9337
  • Fax: 810-400-5979
Mailing address:
  • Phone: 586-876-3559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601013729
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: