Provider Demographics
NPI:1356355804
Name:CROWL, JAMES WILLIAM (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:WILLIAM
Last Name:CROWL
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 1:46325 W. 12 MILE RD
Mailing Address - Street 2:#390
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377
Mailing Address - Country:US
Mailing Address - Phone:248-344-7144
Mailing Address - Fax:248-344-7194
Practice Address - Street 1:46325 W. 12 MILE RD
Practice Address - Street 2:#390
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377
Practice Address - Country:US
Practice Address - Phone:248-344-7144
Practice Address - Fax:248-344-7194
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI039680207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P83672OtherBCN
C2603OtherMCARE
06302002111Medicare ID - Type Unspecified
P83672OtherBCN