Provider Demographics
NPI:1497761100
Name:CARMICHAEL, CRAIG W (MD)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:W
Last Name:CARMICHAEL
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 1:3801 GENERAL ELECTRIC RD STE 4
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61704-4193
Mailing Address - Country:US
Mailing Address - Phone:309-319-2341
Mailing Address - Fax:
Practice Address - Street 1:3801 GENERAL ELECTRIC RD STE 4
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61704-4193
Practice Address - Country:US
Practice Address - Phone:309-319-2341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036102014208VP0014X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036102014Medicaid
ILG53414Medicare UPIN