Provider Demographics
NPI:1699760397
Name:CRAWFORD, MICHAEL E (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:E
Last Name:CRAWFORD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:520 MEDICAL DR
Mailing Address - Street 2:SUITE #310
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-4968
Mailing Address - Country:US
Mailing Address - Phone:801-397-3000
Mailing Address - Fax:801-397-0455
Practice Address - Street 1:5405 S 500 E
Practice Address - Street 2:SUITE #204
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84405-6957
Practice Address - Country:US
Practice Address - Phone:801-479-0184
Practice Address - Fax:801-479-5642
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT323415-1205207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1477643179OtherGROUP NPI
UT005516304Medicare PIN
UT005765601Medicare PIN
UTC32747Medicare UPIN