Provider Demographics
NPI:1659467603
Name:BADE, CRAIG NELIS (MD)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:NELIS
Last Name:BADE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:29 WEST 8TH STREET
Mailing Address - Street 2:SUITE 240
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423
Mailing Address - Country:US
Mailing Address - Phone:616-396-1433
Mailing Address - Fax:616-396-9643
Practice Address - Street 1:29 WEST 8TH STREET
Practice Address - Street 2:SUITE 240
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423
Practice Address - Country:US
Practice Address - Phone:616-396-1433
Practice Address - Fax:616-396-9643
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301039774207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
16070-000081OtherBCBS
MI2109477-IDMedicaid
B44316Medicare UPIN
MI2109477-IDMedicaid