Provider Demographics
NPI:1659368058
Name:GORDON, CRAIG J (DO)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:J
Last Name:GORDON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:30160 ORCHARD LAKE RD
Mailing Address - Street 2:STE 100
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-2254
Mailing Address - Country:US
Mailing Address - Phone:248-522-0222
Mailing Address - Fax:248-522-0225
Practice Address - Street 1:30160 ORCHARD LAKE RD STE 100
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-2254
Practice Address - Country:US
Practice Address - Phone:248-522-0222
Practice Address - Fax:248-522-0225
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101008584207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI137130OtherCARE CHOICES
MI4559260OtherAETNA
MIF02038OtherHAP
MI115532OtherGREAT LAKES HEALTH PLAN
MI3404140Medicaid
MI1156304464OtherBLUE CROSS BLUE SHIELD OF MICHIGAN
MIF02038Medicare UPIN
MI3404140Medicaid