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General NPI Number Information
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NPI Number | 1790017416
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Entity Type | Organization
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Legal Business Name | CHARLES P CRAIG MD PC
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Dates
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Enumeration Date | 02/05/2010
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Last Update Date | 02/05/2010
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Provider Practice Location Address
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Address Line | 4870 W CLARK RD SUITE 204
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City | YPSILANTI
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State | MI
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Zip | 48197-1104
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Country | US
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Telephone | 734-528-9111
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Fax | 734-528-9082
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Provider Business Mailing Address
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Address Line | 4870 W CLARK RD SUITE 204
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City | YPSILANTI
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State | MI
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Zip | 48197-1104
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Country | US
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Telephone | 734-528-9111
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Fax | 734-528-9082
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Authorized Official
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Title or Position | OWNER
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Name | DR. CHARLES POE CRAIG
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Credential | MEDICAL DOCTOR
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Telephone | 734-528-9111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | CC052386
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License Number State | MI
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