Provider Demographics
NPI:1033291141
Name:CRISSINGER, HAROLD P (MD)
Entity Type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:P
Last Name:CRISSINGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3120 RIVERSIDE AVE
Mailing Address - Street 2:GATE B BUILDING 1
Mailing Address - City:MARINETTE
Mailing Address - State:WI
Mailing Address - Zip Code:54143-1123
Mailing Address - Country:US
Mailing Address - Phone:715-732-2075
Mailing Address - Fax:
Practice Address - Street 1:1100 10TH ST
Practice Address - Street 2:
Practice Address - City:MENOMINEE
Practice Address - State:MI
Practice Address - Zip Code:49858-3027
Practice Address - Country:US
Practice Address - Phone:906-863-7897
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301032471207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MION41200021Medicare Oscar/Certification
MI0E56191Medicare PIN
WIK400190690Medicare Oscar/Certification