Crocker, Keith Thomas
Crocker, Keith Thomas is an sole proprietor health care provider with primary practice located at 4300 Cascade Rd Se Ste 103, Grand Rapids MI 49546-3631. He recently has only one registered license in Allopathic & Osteopathic Physicians / Orthopaedic Surgery, which is considered as his primary health care specialty. Crocker, Keith Thomas can be contacted via phone (616) 245-4513.Contact Information
Primary practice address
4300 Cascade Rd Se Ste 103
Grand Rapids MI 49546-3631
Phone: (616) 245-4513
Fax: (616) 245-4802
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Orthopaedic Surgery | 207X00000X | 5101007635 | Michigan |
Profile Details
| NPI number | 1871597419 |
|---|---|
| LBN Legal business name | Crocker, Keith Thomas |
| Credentials | Doctor of Osteopathy (DO) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jun 10th, 2005 |
| Last updated | Dec 5th, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1871597419 | NPPES |
| Michigan | Other | P54539 | BCN |
| Michigan | MEDICAID | 1683584 | BCN |
| Michigan | Other | 5413102 | BCN |
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