Provider Demographics
NPI:1306006051
Name:CRAIG, WENDY MIKULSKI (DO)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:MIKULSKI
Last Name:CRAIG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5200 CENTRE AVE
Mailing Address - Street 2:SUITE 312
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15232-1300
Mailing Address - Country:US
Mailing Address - Phone:412-621-7777
Mailing Address - Fax:412-683-8698
Practice Address - Street 1:5200 CENTRE AVE
Practice Address - Street 2:SUITE 312
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15232-1300
Practice Address - Country:US
Practice Address - Phone:412-621-7777
Practice Address - Fax:412-683-8698
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-16
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS014168207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1023078970001Medicaid