Basic Information
| Provider Information | |||||||||
| NPI: | 1720303753 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CROUCH | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | ALDEN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 45650 SCHOENHERR RD | ||||||||
| Address2: | STE B | ||||||||
| City: | SHELBY TOWNSHIP | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483156033 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5862474300 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1055 N 500 W | ||||||||
| Address2: | STE 222 | ||||||||
| City: | PROVO | ||||||||
| State: | UT | ||||||||
| PostalCode: | 846043305 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8013774623 | ||||||||
| FaxNumber: | 8013776832 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/01/2010 | ||||||||
| LastUpdateDate: | 09/15/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | 9331479-1205 | UT | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
No ID Information.