Provider Demographics
NPI:1437168390
Name:CRAIG, JOEL S (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:S
Last Name:CRAIG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4039 HIGHLAND ST
Mailing Address - Street 2:
Mailing Address - City:MILAN
Mailing Address - State:TN
Mailing Address - Zip Code:38358-3483
Mailing Address - Country:US
Mailing Address - Phone:731-723-3668
Mailing Address - Fax:731-723-3601
Practice Address - Street 1:4039 HIGHLAND ST
Practice Address - Street 2:MILAN FOOT CARE
Practice Address - City:MILAN
Practice Address - State:TN
Practice Address - Zip Code:38358-3483
Practice Address - Country:US
Practice Address - Phone:731-723-3668
Practice Address - Fax:731-723-3601
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN000503213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3352690Medicaid
TN3352690Medicare PIN
U65509Medicare UPIN