Healthcare Provider Details

I. General information

NPI: 1316923428
Provider Name (Legal Business Name): EDWARD E CRAVEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 04/16/2021
Certification Date: 04/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 S OAKLAND ST
SAINT JOHNS MI
48879-2253
US

IV. Provider business mailing address

805 S OAKLAND ST
SAINT JOHNS MI
48879-2253
US

V. Phone/Fax

Practice location:
  • Phone: 989-227-3358
  • Fax: 989-227-3349
Mailing address:
  • Phone: 989-227-3358
  • Fax: 989-227-3349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number4301085500
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: