MEDICARE: DR. MICHAEL KENNETH CRAWFORD 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	207R00000X	Internal Medicine Physician	14749	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5078297	OTHER	OK	AETNA
2	671856	OTHER	OK	FIRST HEALTH

General Provider Information

NPI Number	:	1780689307
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL KENNETH CRAWFORD MD

Provider Business Mailing Address
First Line	:	13321 N MERIDIAN AVE
Second Line	:	STE 210
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-8356
Country	:	US
Telephone Number	:	405-748-4343
Fax Number	:	405-748-5040

Provider Business Practice Location Address
First Line	:	13321 N MERIDIAN AVE
Second Line	:	STE 210
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-8356
Country	:	US
Telephone Number	:	405-748-4343
Fax Number	:	405-748-5040

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

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	04/20/2008

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