Provider Demographics
NPI:1003196254
Name:CRITTENDEN, KEITH ALAN SR (ARRT R (R)(CT))
Entity Type:Individual
Prefix:MR
First Name:KEITH
Middle Name:ALAN
Last Name:CRITTENDEN
Suffix:SR
Gender:M
Credentials:ARRT R (R)(CT)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2404 HUSAK RD
Mailing Address - Street 2:
Mailing Address - City:STANDISH
Mailing Address - State:MI
Mailing Address - Zip Code:48658-9123
Mailing Address - Country:US
Mailing Address - Phone:989-903-5142
Mailing Address - Fax:
Practice Address - Street 1:2404 HUSAK RD
Practice Address - Street 2:
Practice Address - City:STANDISH
Practice Address - State:MI
Practice Address - Zip Code:48658-9123
Practice Address - Country:US
Practice Address - Phone:989-903-5142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-19
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZCRT-156802471C3401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471C3401XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistComputed Tomography