Provider Demographics
NPI:1568484335
Name:VAN CLEAVE, WILLIAM CRAIG (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:CRAIG
Last Name:VAN CLEAVE
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 1:701 WILL HALSEY WAY
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758
Mailing Address - Country:US
Mailing Address - Phone:256-461-7440
Mailing Address - Fax:256-461-7168
Practice Address - Street 1:701 WILL HALSEY WAY
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758
Practice Address - Country:US
Practice Address - Phone:256-461-7440
Practice Address - Fax:256-461-7168
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL28980208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
I47819Medicare UPIN
KY3400341Medicare PIN
KY0264264Medicare PIN
KY0632954Medicare PIN
OH2631834Medicaid
I47819Medicare UPIN
KY0586629Medicare PIN
KY0264264Medicare ID - Type Unspecified