Healthcare Provider Details

I. General information

NPI: 1205961745
Provider Name (Legal Business Name): CRAIG K. MATHESON, D.O., P.L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 02/17/2021
Certification Date: 02/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

821 W US HIGHWAY 10 31
SCOTTVILLE MI
49454-9601
US

IV. Provider business mailing address

821 WEST U.S. HIGHWAY 10
SCOTTVILLE MI
49454
US

V. Phone/Fax

Practice location:
  • Phone: 231-757-2500
  • Fax: 231-757-9073
Mailing address:
  • Phone: 231-757-2500
  • Fax: 231-757-9073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number5101011416
License Number StateMI

VIII. Authorized Official

Name: DR. CRAIG KENNETH MATHESON
Title or Position: OWNER AND SOLE MEMBER
Credential: D.O.
Phone: 231-757-2500