Healthcare Provider Details

I. General information

NPI: 1326154329
Provider Name (Legal Business Name): CRAIG PHILLIP GREENBERG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 08/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1722 SHAFFER ST
KALAMAZOO MI
49048-1633
US

IV. Provider business mailing address

5943 STADIUM DR STE 1
KALAMAZOO MI
49009-3016
US

V. Phone/Fax

Practice location:
  • Phone: 269-226-8321
  • Fax: 269-226-7911
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberMD15850
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number4301102468
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: