Provider Demographics
NPI:1043410723
Name:CRAIG L. MECHELKE, D.O., LTD.
Entity Type:Organization
Organization Name:CRAIG L. MECHELKE, D.O., LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:LOREN
Authorized Official - Last Name:MECHELKE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:480-969-3096
Mailing Address - Street 1:4915 E BASELINE RD
Mailing Address - Street 2:SUITE 126
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-2965
Mailing Address - Country:US
Mailing Address - Phone:480-969-3096
Mailing Address - Fax:480-969-0963
Practice Address - Street 1:4915 E BASELINE RD
Practice Address - Street 2:SUITE 126
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2965
Practice Address - Country:US
Practice Address - Phone:480-969-3096
Practice Address - Fax:480-969-0963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-20
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty