Healthcare Provider Details

I. General information

NPI: 1255481933
Provider Name (Legal Business Name): MICHAEL J. CRAWFORD, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 08/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 COLLEGE AVE NE
GRAND RAPIDS MI
49503-1705
US

IV. Provider business mailing address

415 COLLEGE AVE NE
GRAND RAPIDS MI
49503-1705
US

V. Phone/Fax

Practice location:
  • Phone: 616-458-4205
  • Fax: 616-459-3001
Mailing address:
  • Phone: 616-458-4205
  • Fax: 616-459-3001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number4301034057
License Number StateMI

VIII. Authorized Official

Name: DR. MICHAEL JAMES CRAWFORD
Title or Position: PRESIDENT
Credential: M.D.
Phone: 616-458-4205