Provider Demographics
NPI:1154858785
Name:CRATSLEY, MICHAEL THEODORE (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:THEODORE
Last Name:CRATSLEY
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 1:8423 MARKET ST STE 207
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-6778
Mailing Address - Country:US
Mailing Address - Phone:330-965-5490
Mailing Address - Fax:330-965-5491
Practice Address - Street 1:8423 MARKET ST STE 207
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-6778
Practice Address - Country:US
Practice Address - Phone:330-965-5490
Practice Address - Fax:330-965-5491
Is Sole Proprietor?:No
Enumeration Date:2017-05-14
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.137004207Q00000X, 207QS0010X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0224141Medicaid
OH35.137004OtherOHIO STATE LICENSE
OH0224141Medicaid
AL41086OtherALABAMA STATE MEDICAL BOARD