Organization
ADVANCED DERMATOLOGY AND COSMETIC SURGERY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEVIN MICHAEL CRAWFORD M.D. (DERMATOLOGIST)
(812) 358-7705
Entity
Organization
Contact information
Practice address
303 S WALNUT ST, SEYMOUR, IN 47274-2368
(812) 358-7705
Mailing address
PO BOX 1077, SEYMOUR, IN 47274-1077
(812) 358-7705
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
01063019A
IN
207ND0101X
MOHS-Micrographic Surgery Physician
Primary
01063019A
IN
207NS0135X
Procedural Dermatology Physician
01063019A
IN
Other
Enumeration date
05/28/2008
Last updated
08/08/2011
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