Provider Demographics
NPI:1326037094
Name:CRANE, MIKI M (MD)
Entity Type:Individual
Prefix:DR
First Name:MIKI
Middle Name:M
Last Name:CRANE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:8616 E BROADWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-4014
Mailing Address - Country:US
Mailing Address - Phone:520-468-4809
Mailing Address - Fax:520-337-7260
Practice Address - Street 1:8616 E BROADWAY BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-4014
Practice Address - Country:US
Practice Address - Phone:520-468-4809
Practice Address - Fax:520-337-7260
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101235743207R00000X
DCMD034719207R00000X
OH35-095245207R00000X
AZ51313207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0057667Medicaid
H087990Medicare PIN