Provider Demographics
NPI:1265826655
Name:CRAIG N BADE MD
Entity Type:Organization
Organization Name:CRAIG N BADE MD
Other - Org Name:HOLLAND SKIN AND VEIN CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:HAVERDINK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-396-1433
Mailing Address - Street 1:29 W 8TH ST
Mailing Address - Street 2:STE 220
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-3185
Mailing Address - Country:US
Mailing Address - Phone:616-396-1433
Mailing Address - Fax:616-396-9643
Practice Address - Street 1:29 W 8TH ST
Practice Address - Street 2:STE 220
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-3185
Practice Address - Country:US
Practice Address - Phone:616-396-1433
Practice Address - Fax:616-396-9643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-24
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301008394103T00000X
MI4301039774207V00000X
MI4704233966363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6301008394OtherSTATE LISCENSE
MI4301039774OtherSTATE LISCENSE
MI2109477Medicaid
MI1871743898Medicaid
MI4704233966OtherSTATE LISCENSE
MI1871743898Medicaid
MID16094147Medicare PIN