Provider Demographics
NPI:1598315095
Name:CRAWFORD, GUYLAN M JR
Entity Type:Individual
Prefix:
First Name:GUYLAN
Middle Name:M
Last Name:CRAWFORD
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18434 COYLE ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48235-2828
Mailing Address - Country:US
Mailing Address - Phone:313-413-3971
Mailing Address - Fax:
Practice Address - Street 1:18434 COYLE ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48235-2828
Practice Address - Country:US
Practice Address - Phone:313-413-3971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-17
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide