Individual
NICHOLAS CROFUT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
30200 TELEGRAPH RD, SUITE 220, BINGHAM FARMS, MI 48025-4502
(248) 258-5058
Mailing address
806 GREENWICH DR, GRAND LEDGE, MI 48837-2412
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
4704236483
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104822930
—
MI
01
—
P00293187
RAILROAD MEDICARE
MI
Enumeration date
04/21/2006
Last updated
08/23/2017
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