Provider Demographics
NPI:1447293469
Name:CROOKS, MICHAEL JONATHAN (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JONATHAN
Last Name:CROOKS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:601 JOHN ST
Mailing Address - Street 2:SUITE M170A
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-5341
Mailing Address - Country:US
Mailing Address - Phone:269-381-5060
Mailing Address - Fax:269-381-1655
Practice Address - Street 1:601 JOHN ST
Practice Address - Street 2:SUITE M170A
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-5341
Practice Address - Country:US
Practice Address - Phone:269-381-5060
Practice Address - Fax:269-381-1655
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301071577207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
122888OtherGREAT LAKES HLTH PLN
MI3482502-10Medicaid
7683307OtherAETNA PIN
MI110C910470OtherBCBS GRP PIN
MI1417961137OtherBCBS (BRONSON)
MI0390406OtherBCBS IND PIN
MI1447293469Medicaid
MI1417961137OtherBCBS (BRONSON)
7683307OtherAETNA PIN
MI0390406OtherBCBS IND PIN
MI110C910470OtherBCBS GRP PIN
G73896Medicare UPIN