Provider Demographics
NPI:1558538645
Name:CRAIG J. MCMANAMAN D.O.PLLC
Entity Type:Organization
Organization Name:CRAIG J. MCMANAMAN D.O.PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:MCMANAMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:989-269-5015
Mailing Address - Street 1:1011 S VAN DYKE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:BAD AXE
Mailing Address - State:MI
Mailing Address - Zip Code:48413-9630
Mailing Address - Country:US
Mailing Address - Phone:989-269-5015
Mailing Address - Fax:989-269-6601
Practice Address - Street 1:1011 S VAN DYKE RD
Practice Address - Street 2:SUITE A
Practice Address - City:BAD AXE
Practice Address - State:MI
Practice Address - Zip Code:48413-9630
Practice Address - Country:US
Practice Address - Phone:989-269-5015
Practice Address - Fax:989-269-6601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-08
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICM012814207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI7605172OtherAETNA
MI4395920Medicaid
MI0N53320Medicare UPIN
MIPOOO65332Medicare PIN