Provider Demographics
NPI:1235517434
Name:SCHALLHORN, CRAIG STEVEN (MD)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:STEVEN
Last Name:SCHALLHORN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:490 ILLINOIS ST FL 5
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-2510
Mailing Address - Country:US
Mailing Address - Phone:415-476-1152
Mailing Address - Fax:
Practice Address - Street 1:490 ILLINOIS ST FL 5
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-2510
Practice Address - Country:US
Practice Address - Phone:415-476-1152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-08
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171000000X
IN01081408A207W00000X
CAA143690207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No171000000XOther Service ProvidersMilitary Health Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAVAD0000Medicare UPIN