Healthcare Provider Details

I. General information

NPI: 1821059791
Provider Name (Legal Business Name): CRAIG DAVID SANDERS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2006
Last Update Date: 11/07/2025
Certification Date: 11/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 MAN O WAR BOULEVARD
UNION KY
41091-2007
US

IV. Provider business mailing address

605 MAN O WAR BOULEVARD
UNION KY
41091-2007
US

V. Phone/Fax

Practice location:
  • Phone: 859-578-5333
  • Fax: 859-384-0216
Mailing address:
  • Phone: 859-578-5333
  • Fax: 859-384-0216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number02741
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: