Provider Demographics
NPI:1376589077
Name:SOLEIM, CRAIG RANDOLPH (NAVY IDC)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:RANDOLPH
Last Name:SOLEIM
Suffix:
Gender:M
Credentials:NAVY IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2262 WAIKAHE CT
Mailing Address - Street 2:
Mailing Address - City:PEARL CITY
Mailing Address - State:HI
Mailing Address - Zip Code:96782-3478
Mailing Address - Country:US
Mailing Address - Phone:808-489-9673
Mailing Address - Fax:
Practice Address - Street 1:822 CLARK ST
Practice Address - Street 2:NAVAL SUBMARINE SUPPORT COMMAND MEDICAL
Practice Address - City:PEARL HARBOR
Practice Address - State:HI
Practice Address - Zip Code:96860-4652
Practice Address - Country:US
Practice Address - Phone:808-473-2899
Practice Address - Fax:808-473-3109
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman