MEDICARE: CRAIG STEVEN TRAVIS PHD

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	208D00000X	General Practice Physician	5745	OH

General Provider Information

NPI Number	:	1942249164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRAIG STEVEN TRAVIS PHD

Provider Business Mailing Address
First Line	:	5854 DEE DR
Second Line	:
City	:	HILLIARD
State	:	OH
Zip	:	43026-7333
Country	:	US
Telephone Number	:	614-777-4792
Fax Number	:

Provider Business Practice Location Address
First Line	:	2150 MARBLE CLIFF OFFICE PARK
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43215-1056
Country	:	US
Telephone Number	:	614-234-0400
Fax Number	:

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

Provider Enumeration Date	:	06/05/2006
Last Update Date	:	07/08/2007

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