Healthcare Provider Details

I. General information

NPI: 1417984287
Provider Name (Legal Business Name): CRAIG ALLAN REYNOLDS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 CONNABLE AVENUE ER DEPARTMENT
PETOSKEY MI
49770
US

IV. Provider business mailing address

930 SPRING STREET
PETOSKEY MI
49770
US

V. Phone/Fax

Practice location:
  • Phone: 231-487-4000
  • Fax:
Mailing address:
  • Phone: 800-540-8739
  • Fax: 616-975-9827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberCR008974
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: