Basic Information
| Provider Information | |||||||||
| NPI: | 1477667038 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CROWE | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2821 NEW HARTFORD RD | ||||||||
| Address2: | |||||||||
| City: | OWENSBORO | ||||||||
| State: | KY | ||||||||
| PostalCode: | 423031320 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2708524791 | ||||||||
| FaxNumber: | 2706850190 | ||||||||
| Practice Location | |||||||||
| Address1: | 2821 NEW HARTFORD RD | ||||||||
| Address2: | |||||||||
| City: | OWENSBORO | ||||||||
| State: | KY | ||||||||
| PostalCode: | 423031320 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2708524791 | ||||||||
| FaxNumber: | 2706850190 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2006 | ||||||||
| LastUpdateDate: | 02/24/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | 29360 | KY | N | Allopathic & Osteopathic Physicians | Dermatology | 207ND0101X | 29360 | KY | Y | Allopathic & Osteopathic Physicians | Dermatology | MOHS-Micrographic Surgery | 207ND0900X | 29360 | KY | N | Allopathic & Osteopathic Physicians | Dermatology | Dermatopathology | 207NI0002X | 29360 | KY | N | Allopathic & Osteopathic Physicians | Dermatology | Clinical & Laboratory Dermatological Immunology | 207NP0225X | 29360 | KY | N | Allopathic & Osteopathic Physicians | Dermatology | Pediatric Dermatology | 207NS0135X | 29360 | KY | N | Allopathic & Osteopathic Physicians | Dermatology | Procedural Dermatology |
ID Information
| ID | Type | State | Issuer | Description | 6429360800 | 05 | KY | MEDICAID |