Provider Demographics
NPI:1396711610
Name:CRANDELL, JAMES R (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:CRANDELL
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:PO BOX 378
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44871-0378
Mailing Address - Country:US
Mailing Address - Phone:419-626-6161
Mailing Address - Fax:419-502-3511
Practice Address - Street 1:25200 CENTER RIDGE RD STE 1100
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-4146
Practice Address - Country:US
Practice Address - Phone:440-331-4853
Practice Address - Fax:440-333-7044
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-27
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35059930C207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
9273172OtherGROUP MEDICARE
D368301OtherGROUP IND DIAGNOTICS MED
109934OtherKAISER
0119204OtherGROUP MEDICAID
2448496OtherAETNA
CA4511OtherRR MEDICARE GROUP
10790137OtherCAQH
110213802OtherRR MEDICARE INDIVIDUAL
3610861OtherGROUP ASC MEDICARE
L59930OtherSUMMACARE APEX
341783789055OtherCARESOURCE
000000188027OtherANTHEM
1780634279OtherGROUP NPI
CA4511OtherGROUP RR MEDICARE
OH0805436Medicaid
2502257OtherUNITED HEALTHCARE
109934OtherKAISER
2448496OtherAETNA
OH0724485Medicare PIN