Provider Demographics
NPI:1801854534
Name:CROOK, WILLIAM F (PA)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:F
Last Name:CROOK
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 E WILLIAMS ST
Mailing Address - Street 2:
Mailing Address - City:OWOSSO
Mailing Address - State:MI
Mailing Address - Zip Code:48867-2360
Mailing Address - Country:US
Mailing Address - Phone:989-725-6101
Mailing Address - Fax:989-723-3601
Practice Address - Street 1:113 E WILLIAMS ST
Practice Address - Street 2:
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-2360
Practice Address - Country:US
Practice Address - Phone:989-725-6101
Practice Address - Fax:989-723-3601
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601004363363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
2057815640OtherBCBSM PIN
Q32369Medicare UPIN
0M09140010Medicare PIN
2057815640OtherBCBSM PIN