Provider Demographics
NPI:1083934822
Name:WEINGROW, CRAIG M (MD)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:M
Last Name:WEINGROW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7200 SMOKE RANCH ROAD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128
Mailing Address - Country:US
Mailing Address - Phone:702-570-6611
Mailing Address - Fax:702-685-8941
Practice Address - Street 1:7200 SMOKE RANCH ROAD
Practice Address - Street 2:SUITE 120
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128
Practice Address - Country:US
Practice Address - Phone:702-570-6611
Practice Address - Fax:702-685-8941
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-03
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV14309207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1083934822Medicaid
NVGM231YMedicare PIN
NVGM231ZMedicare PIN
NVGM231YMedicare UPIN