Provider Demographics
NPI:1346276136
Name:WILLIS, CRAIG B (MD)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:B
Last Name:WILLIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3301 MERCY HEALTH BLVD
Mailing Address - Street 2:STE 450
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45211-1106
Mailing Address - Country:US
Mailing Address - Phone:513-981-4263
Mailing Address - Fax:513-215-9397
Practice Address - Street 1:4750 E GALBRAITH RD
Practice Address - Street 2:SUITE 105
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45236-6705
Practice Address - Country:US
Practice Address - Phone:513-981-6784
Practice Address - Fax:513-853-4078
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2017-05-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH35-078249207X00000X, 207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2271198Medicaid
OH2271198Medicaid
OH4061102Medicare PIN