MEDICARE: DR. JASON DONALD CRILE 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
1	207R00000X	Internal Medicine Physician	207R00000X	KY
2	207RC0000X	Cardiovascular Disease Physician	4301101719	MI

General Provider Information

NPI Number	:	1114167988
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASON DONALD CRILE M.D.

Provider Business Mailing Address
First Line	:	1701 SOUTH BLVD E STE 390
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48307-6117
Country	:	US
Telephone Number	:	248-293-0055
Fax Number	:

Provider Business Practice Location Address
First Line	:	1701 SOUTH BLVD E STE 390
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48307-6117
Country	:	US
Telephone Number	:	248-293-0055
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/05/2009
Last Update Date	:	06/26/2015

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Directions to “ DR. JASON DONALD CRILE M.D.” Practice Location

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