Provider Demographics
NPI:1689675282
Name:MARKS, CRAIG T (MD)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:T
Last Name:MARKS
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 1:11109 PARKVIEW PLAZA DR # 117
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11141 PARKVIEW PLAZA DR STE 305
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46845-1715
Practice Address - Country:US
Practice Address - Phone:260-484-9611
Practice Address - Fax:260-484-1004
Is Sole Proprietor?:No
Enumeration Date:2005-08-04
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01040928A208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI103421786Medicaid
OH0116627Medicaid
IN100337150Medicaid
IN020026958OtherMEDICARE RAILROAD
IN667640HMedicare PIN
IN020026958OtherMEDICARE RAILROAD
MI103421786Medicaid
INP00705690Medicare PIN
IN149110MMedicare PIN
IN260100HMedicare PIN
IN150640CCCMedicare PIN