MEDICARE: MICHAEL CRADEUR

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1811790793
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL CRADEUR

Provider Business Mailing Address
First Line	:	42 10TH ST APT 1
Second Line	:
City	:	PROVIDENCE
State	:	RI
Zip	:	02906-2918
Country	:	US
Telephone Number	:	805-279-5465
Fax Number	:

Provider Business Practice Location Address
First Line	:	42 10TH ST APT 1
Second Line	:
City	:	PROVIDENCE
State	:	RI
Zip	:	02906-2918
Country	:	US
Telephone Number	:	805-279-5465
Fax Number	:

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

Provider Enumeration Date	:	03/28/2025
Last Update Date	:	03/28/2025

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Directions to “ MICHAEL CRADEUR ” Practice Location

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