Provider Demographics
NPI:1588910707
Name:CAROL CROUCH-ROSS MD PLLC
Entity type:Organization
Organization Name:CAROL CROUCH-ROSS MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:D
Authorized Official - Last Name:CROUCH-ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-888-0088
Mailing Address - Street 1:19811 FARMINGTON RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-1444
Mailing Address - Country:US
Mailing Address - Phone:248-888-0088
Mailing Address - Fax:248-888-0060
Practice Address - Street 1:19811 FARMINGTON RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-1444
Practice Address - Country:US
Practice Address - Phone:248-888-0088
Practice Address - Fax:248-888-0060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-25
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010641922084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty