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General NPI Number Information
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NPI Number | 1205961745
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Entity Type | Organization
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Legal Business Name | CRAIG K. MATHESON, D.O., P.L.L.C.
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Dates
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Enumeration Date | 02/23/2007
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Last Update Date | 02/17/2021
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Provider Practice Location Address
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Address Line | 821 W US HIGHWAY 10 31
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City | SCOTTVILLE
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State | MI
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Zip | 49454-9601
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Country | US
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Telephone | 231-757-2500
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Fax | 231-757-9073
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Provider Business Mailing Address
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Address Line | 821 WEST U.S. HIGHWAY 10
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City | SCOTTVILLE
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State | MI
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Zip | 49454
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Country | US
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Telephone | 231-757-2500
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Fax | 231-757-9073
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Authorized Official
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Title or Position | OWNER AND SOLE MEMBER
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Name | DR. CRAIG KENNETH MATHESON
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Credential | D.O.
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Telephone | 231-757-2500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 5101011416
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License Number State | MI
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