Healthcare Provider Details

I. General information

NPI: 1588643035
Provider Name (Legal Business Name): CRAIG HUARD CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

790 KENSINGTON LN
BLOOMFIELD HILLS MI
48304-3744
US

IV. Provider business mailing address

5623 E DUNBAR RD
MONROE MI
48161-9127
US

V. Phone/Fax

Practice location:
  • Phone: 734-241-3891
  • Fax: 734-241-0014
Mailing address:
  • Phone: 734-241-3891
  • Fax: 734-241-0014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704144923
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: