Healthcare Provider Details

I. General information

NPI: 1033259361
Provider Name (Legal Business Name): RICHARD CRILL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 PINE GROVE AVE PORT HURON HOSPITAL EMERGENCY DEPT
PORT HURON MI
48060-3511
US

IV. Provider business mailing address

3050 COMMERCE DR SUITE C
FORT GRATIOT MI
48059-3819
US

V. Phone/Fax

Practice location:
  • Phone: 810-987-5000
  • Fax: 810-385-4933
Mailing address:
  • Phone: 810-385-8086
  • Fax: 810-385-4933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number4301084158
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: