Basic Information
| Provider Information | |||||||||
| NPI: | 1679816631 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CRAIG | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | WINSTON | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7545 BEECHMONT AVE. | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452554231 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5133333338 | ||||||||
| FaxNumber: | 5133332584 | ||||||||
| Practice Location | |||||||||
| Address1: | 7545 BEECHMONT AVE. | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452554231 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5133333338 | ||||||||
| FaxNumber: | 5133332584 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2013 | ||||||||
| LastUpdateDate: | 10/21/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213E00000X | 36-003764 | OH | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist |
No ID Information.