Provider Demographics
NPI:1275640617
Name:NEITZEL, CRAIG D (MD)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:D
Last Name:NEITZEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:611 W PARK ST
Mailing Address - Street 2:BWPC
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-2529
Mailing Address - Country:US
Mailing Address - Phone:217-383-6792
Mailing Address - Fax:217-383-4752
Practice Address - Street 1:1701 W. CURTIS ROAD
Practice Address - Street 2:DERMATOLOGY
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61822
Practice Address - Country:US
Practice Address - Phone:217-365-6204
Practice Address - Fax:217-326-1234
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2014-05-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036101453207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILH21834Medicare UPIN
ILIL3270438Medicare PIN
H21834Medicare UPIN
IL6447860004Medicare NSC