Provider Demographics
NPI:1285605626
Name:CRIDER, MICHAEL K (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:K
Last Name:CRIDER
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 1:3310 W PURDUE AVENUE
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-6355
Mailing Address - Country:US
Mailing Address - Phone:765-281-1400
Mailing Address - Fax:765-282-2133
Practice Address - Street 1:3310 W PURDUE AVENUE
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-6355
Practice Address - Country:US
Practice Address - Phone:765-281-1400
Practice Address - Fax:765-282-2133
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01029431207N00000X, 207ZD0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000091505OtherBLUE CROSS
IN466070Medicare ID - Type Unspecified
D95441Medicare UPIN