Provider Demographics
NPI:1821392051
Name:RONALD M. CRAFTON, PC
Entity Type:Organization
Organization Name:RONALD M. CRAFTON, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:M
Authorized Official - Last Name:CRAFTON
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:269-375-5142
Mailing Address - Street 1:5955 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-8700
Mailing Address - Country:US
Mailing Address - Phone:269-375-5142
Mailing Address - Fax:269-375-4193
Practice Address - Street 1:5955 W MAIN ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-8700
Practice Address - Country:US
Practice Address - Phone:269-375-5142
Practice Address - Fax:269-375-4193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-03
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301003927261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOM39270Medicare PIN