MEDICARE: DR. CRAIG J EVERINGHAM D.O.

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	381898373	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5820103	OTHER	MI	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891796371
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CRAIG J EVERINGHAM D.O.

Provider Business Mailing Address
First Line	:	26901 BEAUMONT BLVD STE 3D
Second Line	:
City	:	SOUTHFIELD
State	:	MI
Zip	:	48033-3849
Country	:	US
Telephone Number	:	947-522-1863
Fax Number	:	947-522-0307

Provider Business Practice Location Address
First Line	:	12100 S HURON RIVER DR
Second Line	:
City	:	ROMULUS
State	:	MI
Zip	:	48174-1119
Country	:	US
Telephone Number	:	734-941-1070
Fax Number	:	734-941-1763

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

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	10/22/2020

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