Provider Demographics
NPI:1770922734
Name:CROSSLEY, STEVEN
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:CROSSLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1640 FORT ST
Mailing Address - Street 2:STE D
Mailing Address - City:TRENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48183-2040
Mailing Address - Country:US
Mailing Address - Phone:734-391-3057
Mailing Address - Fax:734-391-3052
Practice Address - Street 1:23050 WEST RD
Practice Address - Street 2:SUITE 260
Practice Address - City:BROWNSTOWN TWP
Practice Address - State:MI
Practice Address - Zip Code:48183-1472
Practice Address - Country:US
Practice Address - Phone:734-671-1867
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-22
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101020986207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0H27501OtherBLUE CROSS
1841564788OtherGROUP NPI HENRY FORD WYANDOTTE
1841564788OtherGROUP NPI HENRY FORD WYANDOTTE