Provider Demographics
NPI:1417900937
Name:FLORINE, CRAIG W (MD)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:W
Last Name:FLORINE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:MEMORIAL MEDICAL CENTER
Mailing Address - Street 2:1615 MAPLE LANE
Mailing Address - City:ASHLAND
Mailing Address - State:WI
Mailing Address - Zip Code:54806
Mailing Address - Country:US
Mailing Address - Phone:715-685-5500
Mailing Address - Fax:715-682-4022
Practice Address - Street 1:MEMORIAL MEDICAL CENTER
Practice Address - Street 2:1615 MAPLE LANE
Practice Address - City:ASHLAND
Practice Address - State:WI
Practice Address - Zip Code:54806
Practice Address - Country:US
Practice Address - Phone:715-685-5500
Practice Address - Fax:715-682-4022
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI34326207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31935800Medicaid
000112004Medicare PIN
F60427Medicare UPIN