Provider Demographics
NPI:1477835122
Name:MICHAEL E CROWE D.O. P.A.
Entity Type:Organization
Organization Name:MICHAEL E CROWE D.O. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:CROWE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:863-471-9330
Mailing Address - Street 1:4511 SUN N LAKE BLVD
Mailing Address - Street 2:108
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33872-2169
Mailing Address - Country:US
Mailing Address - Phone:863-471-9330
Mailing Address - Fax:863-471-9335
Practice Address - Street 1:4511 SUN N LAKE BLVD
Practice Address - Street 2:108
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33872-2169
Practice Address - Country:US
Practice Address - Phone:863-471-9330
Practice Address - Fax:863-471-9335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-19
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS6308207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL370913200Medicaid
FL80692BOtherBLUE CROSS/BLUE SHEILD
FLE50318Medicare UPIN
FL80692BMedicare PIN