Provider Demographics
NPI:1083698419
Name:CROISSANT, RAYMOND CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:CHARLES
Last Name:CROISSANT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6533 DREW AVE S
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2103
Mailing Address - Country:US
Mailing Address - Phone:952-927-7138
Mailing Address - Fax:952-924-4021
Practice Address - Street 1:6533 DREW AVE S
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2103
Practice Address - Country:US
Practice Address - Phone:952-927-7138
Practice Address - Fax:952-924-4021
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-30
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN19945207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN166865000Medicaid
MN182610183Medicare ID - Type Unspecified
B58560Medicare UPIN