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NPI Code Detail

MEDICARE: CRYSTAL DYE M.D.

MEDICARE: CRYSTAL DYE M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1104560572
Entity Type Code : Individual
Provider Name (Legal Business Name) : CRYSTAL DYE M.D.
Provider Business Mailing Address
First Line : 1675 LEAHY ST STE 315A
Second Line :
City : MUSKEGON
State : MI
Zip : 49442-5543
Country : US
Telephone Number : 231-727-5244
Fax Number : 231-727-5223
Provider Business Practice Location Address
First Line : 1500 E SHERMAN BLVD
Second Line :
City : MUSKEGON
State : MI
Zip : 49444-1849
Country : US
Telephone Number : 231-672-2000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/22/2022
Last Update Date : 05/15/2026

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