Provider Demographics
NPI:1447296173
Name:CROWE, PATRICIA M (MD)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:M
Last Name:CROWE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2479 PINE HOLLOW TRL
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48114-8960
Mailing Address - Country:US
Mailing Address - Phone:810-599-4250
Mailing Address - Fax:
Practice Address - Street 1:2479 PINE HOLLOW TRL
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48114-8960
Practice Address - Country:US
Practice Address - Phone:810-599-4250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI050460207PE0004X
MI4301050460207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIPC050460OtherBC/BS
MI11292949OtherCAQH
MI3494906Medicaid
MIPC050460OtherBC/BS
MI11292949OtherCAQH