Healthcare Provider Details

I. General information

NPI: 1922103803
Provider Name (Legal Business Name): MICHAEL E. CROOK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 02/03/2020
Certification Date: 02/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 S 12TH AVE
YAKIMA WA
98902-3115
US

IV. Provider business mailing address

501 S 5TH AVE
YAKIMA WA
98902-3550
US

V. Phone/Fax

Practice location:
  • Phone: 509-575-0114
  • Fax: 509-575-0808
Mailing address:
  • Phone: 509-494-6700
  • Fax: 509-573-6275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD00040061
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: