Provider Demographics
NPI:1396736724
Name:CRANDALL, GENEVIEVE J (MD)
Entity type:Individual
Prefix:DR
First Name:GENEVIEVE
Middle Name:J
Last Name:CRANDALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:43455 SCHOENHERR RD
Mailing Address - Street 2:SUITE TWO
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48313-1951
Mailing Address - Country:US
Mailing Address - Phone:586-726-4823
Mailing Address - Fax:586-726-8365
Practice Address - Street 1:43455 SCHOENHERR RD
Practice Address - Street 2:SUITE 2
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48313-1951
Practice Address - Country:US
Practice Address - Phone:586-726-4823
Practice Address - Fax:586-726-8365
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301070146207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ON15110Medicare ID - Type Unspecified
MIMI4938Medicare PIN
MI0P37910Medicare PIN
MI0N41830Medicare PIN
H21784Medicare UPIN