Healthcare Provider Details

I. General information

NPI: 1528011152
Provider Name (Legal Business Name): CRAIG PAWLOWSKI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 MICHIGAN AVE
LOGANSPORT IN
46947-1580
US

IV. Provider business mailing address

1201 MICHIGAN AVE STE 330
LOGANSPORT IN
46947-1570
US

V. Phone/Fax

Practice location:
  • Phone: 574-753-7541
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01062105A
License Number StateIN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier000000565174
Identifier TypeOTHER
Identifier StateIN
Identifier IssuerBLUE CROSS
# 2
Identifier200818440
Identifier TypeMEDICAID
Identifier StateIN
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: