Healthcare Provider Details

I. General information

NPI: 1437168390
Provider Name (Legal Business Name): JOEL S CRAIG DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 10/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4039 HIGHLAND ST MILAN FOOT CARE
MILAN TN
38358-3483
US

IV. Provider business mailing address

4039 HIGHLAND ST
MILAN TN
38358-3483
US

V. Phone/Fax

Practice location:
  • Phone: 731-723-3668
  • Fax: 731-723-3601
Mailing address:
  • Phone: 731-723-3668
  • Fax: 731-723-3601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number000503
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: