Healthcare Provider Details

I. General information

NPI: 1811979487
Provider Name (Legal Business Name): CRAIG S CHERTACK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 03/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 MEMORIAL DR
BERLIN WI
54923-1243
US

IV. Provider business mailing address

331 FORESTVIEW DR
WILLIAMSVILLE NY
14221-1460
US

V. Phone/Fax

Practice location:
  • Phone: 920-361-1313
  • Fax:
Mailing address:
  • Phone: 716-689-7541
  • Fax: 716-689-7541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number169890
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number169890
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number18247
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: