Individual
DR. KEITH THOMAS CROCKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
4300 CASCADE RD SE, STE 103, GRAND RAPIDS, MI 49546-3631
(616) 245-4513
(616) 245-4802
Mailing address
4300 CASCADE RD SE, STE 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
01
—
5413102
BCBSM
MI
01
—
P54539
BCN
MI
Enumeration date
06/10/2005
Last updated
12/05/2007
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