Healthcare Provider Details

I. General information

NPI: 1699760397
Provider Name (Legal Business Name): MICHAEL E CRAWFORD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 09/30/2021
Certification Date: 09/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5405 S 500 E SUITE #204
OGDEN UT
84405-6957
US

IV. Provider business mailing address

520 MEDICAL DR SUITE #310
BOUNTIFUL UT
84010-4968
US

V. Phone/Fax

Practice location:
  • Phone: 801-479-0184
  • Fax: 801-479-5642
Mailing address:
  • Phone: 801-397-3000
  • Fax: 801-397-0455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number323415-1205
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number323415-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: