Healthcare Provider Details

I. General information

NPI: 1013095496
Provider Name (Legal Business Name): THOMAS L. CRAIG III M.D. INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2225 NOBLE RD
CLEVELAND HEIGHTS OH
44112-1726
US

IV. Provider business mailing address

2225 NOBLE RD
CLEVELAND HEIGHTS OH
44112-1726
US

V. Phone/Fax

Practice location:
  • Phone: 216-761-0330
  • Fax:
Mailing address:
  • Phone: 216-761-0330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number35057208
License Number StateOH

VIII. Authorized Official

Name: DR. THOMAS L CRAIG III
Title or Position: PRESIDENT
Credential: M.D.
Phone: 216-761-0330