Provider Demographics
NPI:1407885627
Name:CRAIG T COCCIA, M.D., P.C.
Entity Type:Organization
Organization Name:CRAIG T COCCIA, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:T
Authorized Official - Last Name:COCCIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:906-225-4575
Mailing Address - Street 1:580 W COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-2705
Mailing Address - Country:US
Mailing Address - Phone:906-225-4575
Mailing Address - Fax:906-225-4578
Practice Address - Street 1:580 W COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-2705
Practice Address - Country:US
Practice Address - Phone:906-225-4575
Practice Address - Fax:906-225-4578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301407491207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1405234032OtherBLUE CROSS BLUE SHIELD MI
MI1405234032OtherBLUE CROSS BLUE SHIELD MI
MIF37917Medicare UPIN