Provider Demographics
NPI:1952305542
Name:CRAYNE, JOHN ARTHUR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ARTHUR
Last Name:CRAYNE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3415 STERNS RD
Mailing Address - Street 2:
Mailing Address - City:LAMBERTVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48144-9576
Mailing Address - Country:US
Mailing Address - Phone:734-847-0538
Mailing Address - Fax:734-847-6669
Practice Address - Street 1:3415 STERNS RD.
Practice Address - Street 2:
Practice Address - City:LAMBERTVILLE
Practice Address - State:MI
Practice Address - Zip Code:48144-9576
Practice Address - Country:US
Practice Address - Phone:734-847-0538
Practice Address - Fax:734-847-6669
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35045336207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0462235Medicaid
MI1529780 TYPE 10Medicaid
MI1529780 TYPE 10Medicaid
MI0580102Medicare PIN
OHCR4056432Medicare PIN