Provider Demographics
NPI:1588669659
Name:NORRIS, CRAIG NEWTON (DO)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:NEWTON
Last Name:NORRIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15520 19 MILE RD
Mailing Address - Street 2:STE 480
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-6332
Mailing Address - Country:US
Mailing Address - Phone:586-228-1010
Mailing Address - Fax:586-228-8570
Practice Address - Street 1:15520 19 MILE RD
Practice Address - Street 2:STE 480
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48038-6332
Practice Address - Country:US
Practice Address - Phone:586-228-1010
Practice Address - Fax:586-228-8570
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101008301207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2570048Medicaid
MI1155000415OtherBLUE CROSS/SHIELD IND PIN
MI4262942Medicaid
MI4262942Medicaid
MI1155000415OtherBLUE CROSS/SHIELD IND PIN
MIN20630001Medicare ID - Type Unspecified
MI383522237OtherEIN
MI4262942Medicaid