Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 01063019A | IN |
N | 207ND0101X | MOHS-Micrographic Surgeon | 01063019A | IN |
N | 207NS0135X | Procedural Dermatology | 01063019A | IN |
NPI | 1417132911 |
---|---|
Provider Name | Dr. Kevin Michael Crawford |
First Address | Manitowoc, WI 54220-4630 |
Second Address | Seymour, IN 47274-2368 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/01/2008 |
Last Update Date | 14/09/2021 |