Basic Information
| Provider Information | |||||||||
| NPI: | 1386814457 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CRAIG | ||||||||
| FirstName: | KETURAH | ||||||||
| MiddleName: | |||||||||
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| Credential: | DPM | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 661495 | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352661495 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059795882 | ||||||||
| FaxNumber: | 2059791248 | ||||||||
| Practice Location | |||||||||
| Address1: | 507 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | LINDEN | ||||||||
| State: | AL | ||||||||
| PostalCode: | 367482025 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3345782357 | ||||||||
| FaxNumber: | 3342955596 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/05/2008 | ||||||||
| LastUpdateDate: | 09/30/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213E00000X | 291 | AL | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist |
ID Information
| ID | Type | State | Issuer | Description | 1386814457 | 05 | AL | MEDICAID | 113458 | 05 | AL | MEDICAID | 113459 | 05 | AL | MEDICAID | 515-47487 | 01 | AL | BC BS OF AL | OTHER | 515-47481 | 01 | AL | BC BS OF ALABAMA | OTHER | 515-47484 | 01 | AL | BC BS OFAL | OTHER | 510-49800 | 01 | AL | BC BS OF AL | OTHER | 510-49801 | 01 | AL | BC BS OF AL | OTHER | 6931751 | 01 | AL | CIGNA | OTHER | 9509124 | 01 | AL | AETNA | OTHER | 113460 | 05 | AL | MEDICAID | 510-49799 | 01 | AL | BC BS OF AL | OTHER |