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General NPI Number Information
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NPI Number | 1255481933
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Entity Type | Organization
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Legal Business Name | MICHAEL J. CRAWFORD, M.D., P.C.
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Dates
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Enumeration Date | 01/12/2007
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Last Update Date | 08/30/2007
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Provider Practice Location Address
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Address Line | 415 COLLEGE AVE NE
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-1705
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Country | US
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Telephone | 616-458-4205
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Fax | 616-459-3001
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Provider Business Mailing Address
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Address Line | 415 COLLEGE AVE NE
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-1705
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Country | US
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Telephone | 616-458-4205
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Fax | 616-459-3001
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL JAMES CRAWFORD
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Credential | M.D.
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Telephone | 616-458-4205
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number | 4301034057
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License Number State | MI
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