Healthcare Provider Details

I. General information

NPI: 1659363182
Provider Name (Legal Business Name): CRAIG L HANSEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 VALLEY VIEW DR
COUNCIL BLUFFS IA
51503-5245
US

IV. Provider business mailing address

1260 VALLEY VIEW DR
COUNCIL BLUFFS IA
51503-5245
US

V. Phone/Fax

Practice location:
  • Phone: 402-609-3000
  • Fax: 402-609-3808
Mailing address:
  • Phone: 402-609-3000
  • Fax: 402-609-3808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number22247
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number22247
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License NumberMD-34632
License Number StateIA
# 4
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD-34632
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: