Provider Demographics
NPI:1538146089
Name:WELTGE, CRAIG WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:WILLIAM
Last Name:WELTGE
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 1:2100 LAKESIDE BLVD
Mailing Address - Street 2:STE 250
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-4351
Mailing Address - Country:US
Mailing Address - Phone:972-422-5941
Mailing Address - Fax:972-881-4390
Practice Address - Street 1:2100 LAKESIDE BLVD
Practice Address - Street 2:STE 250
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082-4351
Practice Address - Country:US
Practice Address - Phone:972-422-5941
Practice Address - Fax:972-881-4390
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4606207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX101841802Medicaid
TX101841803Medicaid
050064760OtherRAILROAD
G34807Medicare UPIN
TX101841802Medicaid
TX88995KMedicare PIN
050064760OtherRAILROAD
TX84731KMedicare PIN