Provider Demographics
NPI:1134461916
Name:CRAIG, KATHLEEN KILLIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:KILLIAN
Last Name:CRAIG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5213 QUEENSFERRY LN
Mailing Address - Street 2:
Mailing Address - City:SHOAL CREEK
Mailing Address - State:AL
Mailing Address - Zip Code:35242-6442
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5213 QUEENSFERRY LN
Practice Address - Street 2:
Practice Address - City:SHOAL CREEK
Practice Address - State:AL
Practice Address - Zip Code:35242-6442
Practice Address - Country:US
Practice Address - Phone:205-335-4382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-20
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALAL10531208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics