MEDICARE: THOMAS L. CRAIG III M.D. INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	173000000X	Legal Medicine	35057208	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000496395	OTHER	OH	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013095496
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THOMAS L. CRAIG III M.D. INC

Provider Business Mailing Address
First Line	:	2225 NOBLE RD
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44112-1726
Country	:	US
Telephone Number	:	216-761-0330
Fax Number	:

Provider Business Practice Location Address
First Line	:	2225 NOBLE RD
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44112-1726
Country	:	US
Telephone Number	:	216-761-0330
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. THOMAS L CRAIG III
Credential	:	M.D.
Telephone Number	:	216-761-0330

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	07/20/2009

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