Provider Demographics
NPI:1952493553
Name:CRATCH, ROBERT IRVING JR (CP)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:IRVING
Last Name:CRATCH
Suffix:JR
Gender:M
Credentials:CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 W LAKE LANSING RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-8526
Mailing Address - Country:US
Mailing Address - Phone:517-336-9300
Mailing Address - Fax:517-336-9301
Practice Address - Street 1:702 W LAKE LANSING RD
Practice Address - Street 2:SUITE E
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-8526
Practice Address - Country:US
Practice Address - Phone:517-336-9300
Practice Address - Fax:517-336-9301
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI17531744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4914790001Medicare NSC