# OTIS LEON CRAWFORD JR

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- **Entity:** Organization
- **Status:** Active
- **Other names:** DOCTORS CREATIVE CARE
- **Organization subpart:** No

## Provider details

- **NPI number:** 1629425855
- **Authorized official:** OTIS CRAWFORD D.O. (PROVIDER)
- **Authorized official phone:** (313) 268-5866

## Contact information

- **Practice address:** 16125 MACK AVE, DETROIT, MI 48224-3644
- **Practice address phone:** (313) 469-9034
- **Mailing address:** 16125 MACK AVE, DETROIT, MI 48224-3644
- **Mailing address phone:** (313) 469-9054

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | — |
| 207X00000X | Orthopaedic Surgery Physician | — | — | — |
| 208D00000X | General Practice Physician | — | NULL | Yes |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 05/18/2016
- **Last updated:** 06/26/2017