Provider Demographics
NPI:1477522761
Name:CRAIG, MICHAEL C (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:C
Last Name:CRAIG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 FORT SANDERS WEST BLVD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-3355
Mailing Address - Country:US
Mailing Address - Phone:865-769-4500
Mailing Address - Fax:865-769-4557
Practice Address - Street 1:260 FORT SANDERS WEST BLVD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-3355
Practice Address - Country:US
Practice Address - Phone:865-558-4400
Practice Address - Fax:865-769-4536
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2017-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN34936208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
3711620OtherMEDICARE PTAN
3711675OtherMEDICARE PTAN
P00775574OtherRAILROAD MEDICARE
TNP00262743OtherRAILROAD MEDICARE
TN4110763OtherBLUE CROSS BLUE SHIELD
TNTN01K6OtherJOHN DEERE HEALTHCARE
G99482Medicare UPIN
TN38625611Medicare PIN
3711620OtherMEDICARE PTAN
TN4110763OtherBLUE CROSS BLUE SHIELD