Basic Information
| Provider Information | |||||||||
| NPI: | 1528350436 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KELMAN | ||||||||
| FirstName: | CRAIG | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 425 PINE RIDGE BLVD STE 300 | ||||||||
| Address2: | |||||||||
| City: | WAUSAU | ||||||||
| State: | WI | ||||||||
| PostalCode: | 544014124 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 425 PINE RIDGE BLVD STE 300 | ||||||||
| Address2: | |||||||||
| City: | WAUSAU | ||||||||
| State: | WI | ||||||||
| PostalCode: | 54401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7158472000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2011 | ||||||||
| LastUpdateDate: | 06/27/2018 | ||||||||
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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 | 207T00000X | 0101262140 | VA | N | Allopathic & Osteopathic Physicians | Neurological Surgery | 207T00000X | 68818-20 | WI | Y | Allopathic & Osteopathic Physicians | Neurological Surgery |
No ID Information.