Healthcare Provider Details

I. General information

NPI: 1164764999
Provider Name (Legal Business Name): DARREN LESLIE CROO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2013
Last Update Date: 03/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3874 PLEASANT RIDGE DR
WILLIAMSBURG MI
49690-9323
US

IV. Provider business mailing address

3874 PLEASANT RIDGE DR
WILLIAMSBURG MI
49690-9323
US

V. Phone/Fax

Practice location:
  • Phone: 231-645-2681
  • Fax:
Mailing address:
  • Phone: 231-645-2681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number110265
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: