Provider Demographics
NPI:1699754754
Name:CROISSANT, PAUL D (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:D
Last Name:CROISSANT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:44555 WOODWARD AVE STE 307
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341-5035
Mailing Address - Country:US
Mailing Address - Phone:248-484-5303
Mailing Address - Fax:488-585-8692
Practice Address - Street 1:44555 WOODWARD AVE STE 307
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-5035
Practice Address - Country:US
Practice Address - Phone:248-484-5303
Practice Address - Fax:488-585-8692
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2020-03-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301029245207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI01008146OtherHEALTH PLUS OF MICHIGAN
MI700F318300OtherBLUE CROSS BLUE SHIELD
MIB44980OtherHEALTH ALLIANCE PLANS
MIP00331429OtherRAILROAD MEDICARE
MI0636905OtherBCBSM
MIC4370OtherM-CARE
MI0004459938OtherAETNA HEALTH PLANS
MI104851988Medicaid
MI1699754754Medicaid
MI101507OtherPREFERRED CHOICES
MI0636905OtherBCBSM