Provider Demographics
NPI:1154515369
Name:MICHAEL J CRAWFORD MD PC
Entity type:Organization
Organization Name:MICHAEL J CRAWFORD MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:616-458-4205
Mailing Address - Street 1:415 COLLEGE AVE NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-1705
Mailing Address - Country:US
Mailing Address - Phone:616-458-4205
Mailing Address - Fax:616-459-3001
Practice Address - Street 1:415 COLLEGE AVE NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-1705
Practice Address - Country:US
Practice Address - Phone:616-458-4205
Practice Address - Fax:616-459-3001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-30
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301034057207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1498399Medicaid
MIA76496Medicare UPIN
MI1498399Medicaid