Basic Information
| Provider Information | |||||||||
| NPI: | 1588669659 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NORRIS | ||||||||
| FirstName: | CRAIG | ||||||||
| MiddleName: | NEWTON | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15520 19 MILE RD | ||||||||
| Address2: | STE 480 | ||||||||
| City: | CLINTON TWP | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480386332 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5862281010 | ||||||||
| FaxNumber: | 5862288570 | ||||||||
| Practice Location | |||||||||
| Address1: | 15520 19 MILE RD | ||||||||
| Address2: | STE 480 | ||||||||
| City: | CLINTON TWP | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480386332 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5862281010 | ||||||||
| FaxNumber: | 5862288570 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2005 | ||||||||
| LastUpdateDate: | 09/10/2007 | ||||||||
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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 | 207RN0300X | 5101008301 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 2570048 | 05 | MI | MEDICAID | 1155000415 | 01 | MI | BLUE CROSS/SHIELD IND PIN | OTHER | 4262942 | 05 | MI | MEDICAID |