Provider Demographics
NPI:1437261815
Name:CRITTENDEN MD, DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:CRITTENDEN MD
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 1:11604 BALDWIN RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48838
Mailing Address - Country:US
Mailing Address - Phone:616-894-6290
Mailing Address - Fax:616-225-8967
Practice Address - Street 1:123 E CASS ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MI
Practice Address - Zip Code:48838-1905
Practice Address - Country:US
Practice Address - Phone:616-225-8707
Practice Address - Fax:616-225-8967
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDC062834207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIDC062834OtherSTATE LICENSE NUMBER
MIDC062834OtherSTATE LICENSE NUMBER
MIF19220Medicare UPIN