Provider Demographics
NPI:1780689307
Name:CRAWFORD, MICHAEL KENNETH (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:KENNETH
Last Name:CRAWFORD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:13321 N MERIDIAN AVE
Mailing Address - Street 2:STE 210
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-8356
Mailing Address - Country:US
Mailing Address - Phone:405-748-4343
Mailing Address - Fax:405-748-5040
Practice Address - Street 1:13321 N MERIDIAN AVE
Practice Address - Street 2:STE 210
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-8356
Practice Address - Country:US
Practice Address - Phone:405-748-4343
Practice Address - Fax:405-748-5040
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK14749207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK5078297OtherAETNA
OK671856OtherFIRST HEALTH
OK671856OtherFIRST HEALTH
OK$$$$$$$$$002OtherBLUE CROSS BLUE SHIELD