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NPI Code Detail

MEDICARE: MARY CRONKRIGHT PAC

MEDICARE:   MARY  CRONKRIGHT  PAC
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
1363A00000XPhysician Assistant5601002954MI

General Provider Information

NPI Number : 1467502914
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY CRONKRIGHT PAC
Provider Business Mailing Address
First Line : 401 S BALLENGER HWY
Second Line :
City : FLINT
State : MI
Zip : 48532-3638
Country : US
Telephone Number : 810-342-1000
Fax Number : 810-342-1591
Provider Business Practice Location Address
First Line : 3720 KATALIN CT STE 201
Second Line :
City : BAY CITY
State : MI
Zip : 48706-2160
Country : US
Telephone Number : 989-893-9705
Fax Number : 989-893-8206
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/10/2007
Last Update Date : 12/07/2012

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Directions to “ MARY CRONKRIGHT PAC” Practice Location

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