Provider Demographics
NPI:1588770184
Name:CRAWFORD, CLIFFORD E (MD)
Entity type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:E
Last Name:CRAWFORD
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 1:1100 SOUTHFIELD DR STE 1370
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46168-4300
Mailing Address - Country:US
Mailing Address - Phone:317-837-5566
Mailing Address - Fax:317-837-5580
Practice Address - Street 1:208 MEADOW DR
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IN
Practice Address - Zip Code:46122-1416
Practice Address - Country:US
Practice Address - Phone:317-718-0044
Practice Address - Fax:317-745-5219
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01034101A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100251790Medicaid
010018038OtherRAILROAD MCARE PALAMETTO
000000089609OtherANTHEM
IN192770VMedicare PIN
C25923Medicare UPIN
010018038OtherRAILROAD MCARE PALAMETTO
000000089609OtherANTHEM