=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518642834
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DAVID ALLEN CROWL JR.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/15/2023
-----------------------------------------------------
Last Update Date | 07/16/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 442 MAINCENTRE
-----------------------------------------------------
City | NORTHVILLE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48167-1565
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-658-4765
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 442 MAINCENTRE
-----------------------------------------------------
City | NORTHVILLE
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48167-1565
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-658-4765
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN
-----------------------------------------------------
Name | DAVID CROWL
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 734-658-4765
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------