Provider Demographics
NPI:1588798060
Name:MICHAEL D CRAGEL DPM
Entity Type:Organization
Organization Name:MICHAEL D CRAGEL DPM
Other - Org Name:MICHAEL D CRAGEL DPM KHASE A WILKINSON DPM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DONALD
Authorized Official - Last Name:CRAGEL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:419-693-4171
Mailing Address - Street 1:715 S COY RD
Mailing Address - Street 2:
Mailing Address - City:OREGON
Mailing Address - State:OH
Mailing Address - Zip Code:43616-3007
Mailing Address - Country:US
Mailing Address - Phone:419-693-4171
Mailing Address - Fax:419-693-6863
Practice Address - Street 1:715 S COY RD
Practice Address - Street 2:
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-3007
Practice Address - Country:US
Practice Address - Phone:419-693-4171
Practice Address - Fax:419-693-6863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2026213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0497752OtherMEDICAID INDIVIDUAL
OH1134248099OtherDME GROUP NPI
OH2234639Medicaid
OH9252891OtherMEDICARE,GROUP
OH0497752OtherMEDICAID INDIVIDUAL
OH0517872Medicare PIN