Provider Demographics
NPI:1639163843
Name:HAMMES, CRAIG STEPHEN (MD)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:STEPHEN
Last Name:HAMMES
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 1:11995 SINGLETREE LN
Mailing Address - Street 2:SUITE 500
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-5347
Mailing Address - Country:US
Mailing Address - Phone:952-595-1242
Mailing Address - Fax:952-935-2757
Practice Address - Street 1:885 1650 LN
Practice Address - Street 2:
Practice Address - City:DELTA
Practice Address - State:CO
Practice Address - Zip Code:81416-8107
Practice Address - Country:US
Practice Address - Phone:952-595-1242
Practice Address - Fax:952-935-2757
Is Sole Proprietor?:No
Enumeration Date:2005-09-01
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO325682085N0904X, 2085R0202X, 2085R0204X, 2085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
483724787OtherCHAMPUS
COHAC2708OtherBLUE CROSS BLUE SHIELD
CO01325687Medicaid
AZ195679Medicaid
CO841184495001OtherRMHP
CAXPY185580Medicaid
COC808633Medicare PIN
COE73408Medicare UPIN
COC2738Medicare ID - Type Unspecified
AZ195679Medicaid
CAXPY185580Medicaid