Provider Demographics
NPI:1407838238
Name:STEVENS, CRAIG A (MD)
Entity Type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:A
Last Name:STEVENS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1301 PENN AVENUE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50316-2364
Mailing Address - Country:US
Mailing Address - Phone:515-263-2400
Mailing Address - Fax:515-263-2540
Practice Address - Street 1:1301 PENN AVENUE
Practice Address - Street 2:SUITE 100
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50316-2364
Practice Address - Country:US
Practice Address - Phone:515-263-2400
Practice Address - Fax:515-263-2540
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-26488207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA4047688Medicaid
IA1407838238Medicaid
IA4047688Medicaid
IA719260368Medicare PIN
IAI8659004Medicare PIN
IAA03612Medicare UPIN