Provider Demographics
NPI:1275528838
Name:CROSBY, THOMAS W (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:W
Last Name:CROSBY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1200 SIXTH ST
Mailing Address - Street 2:PO BOX 1627
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-2369
Mailing Address - Country:US
Mailing Address - Phone:231-935-5800
Mailing Address - Fax:231-935-5822
Practice Address - Street 1:1200 SIXTH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-2369
Practice Address - Country:US
Practice Address - Phone:231-935-5800
Practice Address - Fax:231-935-5822
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2013-02-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI43010075406207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4730534Medicaid
MIB04463Medicare UPIN
MIMI3686004Medicare PIN
MI4730534Medicaid