Provider Demographics
NPI:1225089220
Name:CRISSINGER, KAREN D (MD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:D
Last Name:CRISSINGER
Suffix:
Gender:F
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:PO BOX 40480
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36640-0480
Mailing Address - Country:US
Mailing Address - Phone:251-410-5437
Mailing Address - Fax:251-434-3852
Practice Address - Street 1:1601 CENTER STREET
Practice Address - Street 2:SUITE 1S
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36604-3207
Practice Address - Country:US
Practice Address - Phone:251-410-5437
Practice Address - Fax:251-434-3852
Is Sole Proprietor?:No
Enumeration Date:2006-05-14
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL125792080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00125228Medicaid
AL12-00051OtherUNITED HEALTHCARE
AL51502455OtherBCBS 1700 CENTER ST
AL009951870Medicaid
AL51502454OtherBCBS
AL009951880Medicaid
FL261243700Medicaid
AL51502455OtherBCBS 1700 CENTER ST
FL261243700Medicaid
AL12-00051OtherUNITED HEALTHCARE