MEDICARE: CRAIG W ELLIOTT 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	207R00000X	Internal Medicine Physician	4301039064	MI

General Provider Information

NPI Number	:	1255323853
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRAIG W ELLIOTT MD

Provider Business Mailing Address
First Line	:	100 MICHIGAN STREET NE MC845
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49503-2560
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2009 HOLTON RD
Second Line	:
City	:	N MUSKEGON
State	:	MI
Zip	:	49445-1578
Country	:	US
Telephone Number	:	231-291-8399
Fax Number	:	231-291-8397

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

Provider Enumeration Date	:	08/19/2005
Last Update Date	:	12/12/2016

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