Organization
K. THOMAS CROCKER, D.O., P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KERRI S THOMPSON (OFFICE MANAGER)
(616) 245-4513
Entity
Organization
Contact information
Practice address
4300 CASCADE RD SE, SUITE 103, GRAND RAPIDS, MI 49546-3631
(616) 245-4513
(616) 245-4802
Mailing address
4300 CASCADE RD SE, SUITE 103, GRAND RAPIDS, MI 49546-3631
(616) 245-4513
(616) 245-4802
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
5101007635
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1683584
—
MI
Enumeration date
12/20/2007
Last updated
12/20/2007
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