Provider Demographics
NPI:1144265430
Name:DARLING, CRYSTAL FAITH (MD)
Entity type:Individual
Prefix:MS
First Name:CRYSTAL
Middle Name:FAITH
Last Name:DARLING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:CRYSTAL
Other - Middle Name:FAITH
Other - Last Name:GREEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3264 N EVERGREEN DR NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-9746
Mailing Address - Country:US
Mailing Address - Phone:616-363-7339
Mailing Address - Fax:616-631-5828
Practice Address - Street 1:1234 NAPIER AVE
Practice Address - Street 2:
Practice Address - City:ST JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085
Practice Address - Country:US
Practice Address - Phone:269-983-8300
Practice Address - Fax:269-983-6965
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010791772085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4862210Medicaid
MI4862210Medicaid
H51458Medicare UPIN