Healthcare Provider Details

I. General information

NPI: 1497761100
Provider Name (Legal Business Name): CRAIG W CARMICHAEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 03/09/2022
Certification Date: 03/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 GENERAL ELECTRIC RD STE 4
BLOOMINGTON IL
61704-4193
US

IV. Provider business mailing address

3801 GENERAL ELECTRIC RD STE 4
BLOOMINGTON IL
61704-4193
US

V. Phone/Fax

Practice location:
  • Phone: 309-319-2341
  • Fax:
Mailing address:
  • Phone: 309-319-2341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number036102014
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number036102014
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: