Provider Demographics
NPI:1659363182
Name:HANSEN, CRAIG L (MD)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:L
Last Name:HANSEN
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 1:1 EDMUNDSON PL STE 200
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-4658
Mailing Address - Country:US
Mailing Address - Phone:712-396-4020
Mailing Address - Fax:712-396-4025
Practice Address - Street 1:1 EDMUNDSON PL STE 200
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-4658
Practice Address - Country:US
Practice Address - Phone:712-396-4020
Practice Address - Fax:712-396-4025
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-34632207XS0114X, 207X00000X
NE22247207XS0114X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA3266114Medicaid
IA1266114Medicaid
IA4266114Medicaid
IA5266114Medicaid
IA31117OtherWELLMARK - BCBS IA
NE47602554420Medicaid
IA4266114Medicaid
NE47602554420Medicaid
NE47602554412Medicaid
IA1266114Medicaid