Basic Information
| Provider Information | |||||||||
| NPI: | 1255392361 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CRAIG | ||||||||
| FirstName: | CURTIS | ||||||||
| MiddleName: | PATRICK | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 64580 VAN DYKE RD | ||||||||
| Address2: | SUITE C | ||||||||
| City: | WASHINGTON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480952857 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5867529629 | ||||||||
| FaxNumber: | 5867524099 | ||||||||
| Practice Location | |||||||||
| Address1: | 64580 VAN DYKE RD | ||||||||
| Address2: | SUITE C | ||||||||
| City: | WASHINGTON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480952857 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5867529629 | ||||||||
| FaxNumber: | 5867524099 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2006 | ||||||||
| LastUpdateDate: | 04/07/2014 | ||||||||
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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 | 207Q00000X | 4301048055 | MI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 4373772 | 05 | MI | MEDICAID |