Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 35.137004 | OH |
N | 207Q00000X | Family Doctor | MD.41086 | AL |
Y | 207QS0010X | Family Doctor - Sports Medicine | 35.137004 | OH |
NPI | 1154858785 |
---|---|
Provider Name | Dr. Michael Theodore Cratsley |
First Address | Boardman, OH 44512-5900 |
Second Address | Boardman, OH 44512-5900 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2017 |
Last Update Date | 06/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0224141 | (05) | OH |
146387 | FLORIDA STATE MEDICAL LICENSE (01) | FL |
35.137004 | OHIO STATE LICENSE (01) | OH |
41086 | ALABAMA STATE MEDICAL BOARD (01) | AL |