MEDICARE: DR. CRYSTAL FAUN TOTTEN MD

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	208600000X	Surgery Physician	47993	KY
2	208600000X	Surgery Physician	35120102	OH

General Provider Information

NPI Number	:	1740415736
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CRYSTAL FAUN TOTTEN MD

Provider Business Mailing Address
First Line	:	30 WARDER ST STE 220
Second Line	:
City	:	SPRINGFIELD
State	:	OH
Zip	:	45504-2581
Country	:	US
Telephone Number	:	937-521-4823
Fax Number	:	937-521-4825

Provider Business Practice Location Address
First Line	:	30 WARDER ST STE 220
Second Line	:
City	:	SPRINGFIELD
State	:	OH
Zip	:	45504-2581
Country	:	US
Telephone Number	:	937-521-4823
Fax Number	:	937-521-4825

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

Provider Enumeration Date	:	05/20/2009
Last Update Date	:	09/25/2018

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