Doctor Name: | MR. PHILIP JAY CRUM |
NPI Number: | 1306993894 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | A.T.,C. |
License Number: | |
Business Practice Address: | 6500 25 Mile Rd Shelby Township, MI - 483161703 |
Business Phone Number: | 5867971300 |
Business Fax Number: | 5867971301 |
Mailing Address: | 71843 East Pond Creek, BRUCE TWP |
State: | MI |
Postal Code: | 48065 |
Phone Number: | 5863317009 |
Fax Number: | |
NPI Enumeration Date: | 01/05/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |