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NPI Code Detail

MEDICARE: LEAH DIANE CRAFT M.D.

MEDICARE: LEAH DIANE CRAFT M.D.
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
1207Q00000XFamily Medicine Physician01068999AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1467687277
Entity Type Code : Individual
Provider Name (Legal Business Name) : LEAH DIANE CRAFT M.D.
Provider Business Mailing Address
First Line : 710 N NILES AVE
Second Line :
City : SOUTH BEND
State : IN
Zip : 46617-1924
Country : US
Telephone Number : 574-647-1610
Fax Number : 574-237-6069
Provider Business Practice Location Address
First Line : 2235 CLEVELAND RD
Second Line :
City : SOUTH BEND
State : IN
Zip : 46628-3529
Country : US
Telephone Number : 574-647-4530
Fax Number : 574-647-2285
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/22/2009
Last Update Date : 03/31/2021

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Directions to “ LEAH DIANE CRAFT M.D.” Practice Location

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