Provider Demographics
NPI:1790725372
Name:CARLSON, CRAIG L (MD)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:L
Last Name:CARLSON
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 1:5500 S SPY GLASS CIR
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-6406
Mailing Address - Country:US
Mailing Address - Phone:605-330-0044
Mailing Address - Fax:
Practice Address - Street 1:1100 E 26TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-4023
Practice Address - Country:US
Practice Address - Phone:605-338-7098
Practice Address - Fax:605-335-3505
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1642207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0006401OtherBLUE CROSS SD
IA1978056Medicaid
MN96878200Medicaid
MN34P52CAOtherBLUE CROSS MN
SD5700312Medicaid
MN34P52CAOtherBLUE CROSS MN
MN96878200Medicaid