Provider Demographics
NPI:1497888176
Name:FUELLING, CRAIG ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:ALAN
Last Name:FUELLING
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 1:3725 S HILL RD
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48381-3535
Mailing Address - Country:US
Mailing Address - Phone:734-455-3361
Mailing Address - Fax:734-975-1604
Practice Address - Street 1:3725 S HILL RD
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MI
Practice Address - Zip Code:48381-3535
Practice Address - Country:US
Practice Address - Phone:734-455-3361
Practice Address - Fax:734-975-1604
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43014058732084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIE86611Medicare UPIN