Provider Demographics
NPI:1255481933
Name:MICHAEL J. CRAWFORD, M.D., P.C.
Entity Type:Organization
Organization Name:MICHAEL J. CRAWFORD, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:616-458-4205
Mailing Address - Street 1:415 COLLEGE AVE NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-1705
Mailing Address - Country:US
Mailing Address - Phone:616-458-4205
Mailing Address - Fax:616-459-3001
Practice Address - Street 1:415 COLLEGE AVE NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-1705
Practice Address - Country:US
Practice Address - Phone:616-458-4205
Practice Address - Fax:616-459-3001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301034057332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1498399Medicaid
MI0410764Medicare ID - Type Unspecified
MI1498399Medicaid