Provider Demographics
NPI:1578569463
Name:CATTELL, ALBERT CRAIG (MD)
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:CRAIG
Last Name:CATTELL
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 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9008
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:305 E EISENHOWER PKWY STE 320
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-3348
Practice Address - Country:US
Practice Address - Phone:734-800-2055
Practice Address - Fax:734-800-2056
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAC036627.207ND0101X
MIAC036627207NS0135X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1422078-10Medicaid
MIA78253Medicare UPIN
MI1422078-10Medicaid
791023982Medicare PIN