MEDICARE: CRAIG A MEHLDAU M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	22379	CT

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00209593	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336197193
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRAIG A MEHLDAU M.D.

Provider Business Mailing Address
First Line	:	499 FARMINGTON AVE
Second Line	:	SUITE 100
City	:	FARMINGTON
State	:	CT
Zip	:	06032-1943
Country	:	US
Telephone Number	:	860-678-0202
Fax Number	:	860-678-0224

Provider Business Practice Location Address
First Line	:	499 FARMINGTON AVE
Second Line	:	SUITE 100
City	:	FARMINGTON
State	:	CT
Zip	:	06032-1943
Country	:	US
Telephone Number	:	860-678-0202
Fax Number	:	860-678-0224

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	02/02/2016

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Directions to “ CRAIG A MEHLDAU M.D.” Practice Location

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