Provider Demographics
NPI:1104835131
Name:MCCRIRIE, DALE R (DO)
Entity Type:Individual
Prefix:DR
First Name:DALE
Middle Name:R
Last Name:MCCRIRIE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:451 HIDDEN MEADOWS DR
Mailing Address - Street 2:STE 260
Mailing Address - City:HILLSDALE
Mailing Address - State:MI
Mailing Address - Zip Code:49242
Mailing Address - Country:US
Mailing Address - Phone:517-437-5350
Mailing Address - Fax:517-437-8328
Practice Address - Street 1:451 HIDDEN MEADOWS DR
Practice Address - Street 2:STE 260
Practice Address - City:HILLSDALE
Practice Address - State:MI
Practice Address - Zip Code:49242
Practice Address - Country:US
Practice Address - Phone:517-437-5350
Practice Address - Fax:517-437-8328
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MIDM010091208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2893503Medicaid
MI5460026Medicare ID - Type Unspecified
MI2893503Medicaid