Provider Demographics
NPI:1770509952
Name:LITZ, CRAIG EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:EDWARD
Last Name:LITZ
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 1:1355 RIVER BEND DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75247-4915
Mailing Address - Country:US
Mailing Address - Phone:214-638-2000
Mailing Address - Fax:214-631-6724
Practice Address - Street 1:1355 RIVER BEND DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75247-4915
Practice Address - Country:US
Practice Address - Phone:214-638-2000
Practice Address - Fax:214-631-6724
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2524207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX038089101Medicaid
TX220021904OtherRAILROAD MEDICARE
TX038089103Medicaid
TX220021904OtherRAILROAD MEDICARE
TXE15770Medicare UPIN
TX038089101Medicaid