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NPI Code Detail

MEDICARE: CHARLES CRAIG PA-C

MEDICARE: CHARLES CRAIG PA-C
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
1363A00000XPhysician Assistant5601011502MI

General Provider Information

NPI Number : 1932812369
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHARLES CRAIG PA-C
Provider Business Mailing Address
First Line : 4100 EMBASSY DR SE STE 400
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49546-2416
Country : US
Telephone Number : 616-975-1845
Fax Number :
Provider Business Practice Location Address
First Line : 1840 WEALTHY ST SE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49506-2921
Country : US
Telephone Number : 616-391-1730
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/30/2022
Last Update Date : 02/06/2026

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Directions to “ CHARLES CRAIG PA-C” Practice Location

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