Provider Demographics
NPI:1477854941
Name:CROTTY, DEBORAH (RT, AB,NE, OG-GYN,)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:CROTTY
Suffix:
Gender:F
Credentials:RT, AB,NE, OG-GYN,
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 510
Mailing Address - Street 2:
Mailing Address - City:UNION LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48387-0510
Mailing Address - Country:US
Mailing Address - Phone:248-752-6589
Mailing Address - Fax:
Practice Address - Street 1:598 JACOB WAY APT 104
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48307-2292
Practice Address - Country:US
Practice Address - Phone:248-752-6589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-15
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
26932OtherARDMS