Healthcare Provider Details

I. General information

NPI: 1275532780
Provider Name (Legal Business Name): MICHAEL J CRAWFORD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 07/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 EAST BELTINE
GRAND RAPIDS MI
49525
US

IV. Provider business mailing address

750 EAST BELTINE
GRAND RAPIDS MI
49525
US

V. Phone/Fax

Practice location:
  • Phone: 616-949-2600
  • Fax:
Mailing address:
  • Phone: 616-949-2600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number4301034057
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: