Healthcare Provider Details

I. General information

NPI: 1952938532
Provider Name (Legal Business Name): MICHAEL CRIMMINS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2020
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 N MAYFAIR RD STE 500
WAUWATOSA WI
53226-1415
US

IV. Provider business mailing address

2500 N MAYFAIR RD STE 500
WAUWATOSA WI
53226-1415
US

V. Phone/Fax

Practice location:
  • Phone: 414-257-2525
  • Fax: 414-257-1772
Mailing address:
  • Phone: 414-257-2525
  • Fax: 414-257-1772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberD98631
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number84321
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: