MEDICARE: DR. LORI M CRAGO MD

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	207Q00000X	Family Medicine Physician	4301054265	MI

General Provider Information

NPI Number	:	1144223868
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LORI M CRAGO MD

Provider Business Mailing Address
First Line	:	PO BOX 533
Second Line	:
City	:	GRAYLING
State	:	MI
Zip	:	49738-0533
Country	:	US
Telephone Number	:	231-876-7857
Fax Number	:	231-876-7176

Provider Business Practice Location Address
First Line	:	7985 MACKINAW TRL
Second Line	:
City	:	CADILLAC
State	:	MI
Zip	:	49601-8111
Country	:	US
Telephone Number	:	231-876-6200
Fax Number	:	231-779-5290

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	11/23/2020

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