Provider Demographics
NPI:1851388177
Name:CRAWFORD, KEVIN T (DO)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:T
Last Name:CRAWFORD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8722 RELIABLE PARKWAY
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60686-0001
Mailing Address - Country:US
Mailing Address - Phone:248-290-2940
Mailing Address - Fax:248-290-2941
Practice Address - Street 1:33000 ANNAPOLIS ST
Practice Address - Street 2:SUITE 120
Practice Address - City:WAYNE
Practice Address - State:MI
Practice Address - Zip Code:48184-2917
Practice Address - Country:US
Practice Address - Phone:734-721-8785
Practice Address - Fax:734-721-2938
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101010624207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI113209913Medicaid
E78164Medicare UPIN
MI113209913Medicaid