Healthcare Provider Details

I. General information

NPI: 1790725372
Provider Name (Legal Business Name): CRAIG L CARLSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 04/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 E 26TH ST
SIOUX FALLS SD
57105-4023
US

IV. Provider business mailing address

5500 S SPY GLASS CIR
SIOUX FALLS SD
57108-6406
US

V. Phone/Fax

Practice location:
  • Phone: 605-338-7098
  • Fax: 605-335-3505
Mailing address:
  • Phone: 605-330-0044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number1642
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: