Provider Demographics
NPI:1164503389
Name:CRAIG W ENGLUND MD PA
Entity Type:Organization
Organization Name:CRAIG W ENGLUND MD PA
Other - Org Name:CITRUS HEMATOLOGY & ONCOLOGY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SERVILLANO
Authorized Official - Middle Name:E
Authorized Official - Last Name:DELA CRUZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:352-795-6674
Mailing Address - Street 1:770 SE 5TH TER
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL RIVER
Mailing Address - State:FL
Mailing Address - Zip Code:34429-4852
Mailing Address - Country:US
Mailing Address - Phone:352-795-6674
Mailing Address - Fax:352-795-2017
Practice Address - Street 1:770 SE 5TH TER
Practice Address - Street 2:
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34429-4852
Practice Address - Country:US
Practice Address - Phone:352-795-6674
Practice Address - Fax:352-795-2017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL375126100Medicaid
FL24530Medicare ID - Type Unspecified