Provider Demographics
NPI:1487030839
Name:CORDEIRO, CRAIG (CRNA)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:
Last Name:CORDEIRO
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37640 DORCHESTER DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-1861
Mailing Address - Country:US
Mailing Address - Phone:734-223-6047
Mailing Address - Fax:
Practice Address - Street 1:37640 DORCHESTER DR
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48331-1861
Practice Address - Country:US
Practice Address - Phone:734-223-6047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-09
Last Update Date:2015-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704278360367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered