Provider Demographics
NPI:1790760734
Name:THAME, CRAIG H (MD)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:H
Last Name:THAME
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:PO BOX 1547
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-1547
Mailing Address - Country:US
Mailing Address - Phone:877-440-0482
Mailing Address - Fax:317-705-5060
Practice Address - Street 1:5352 LINTON BLVD
Practice Address - Street 2:ATTN: RADIOLOGY DEPT
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-6514
Practice Address - Country:US
Practice Address - Phone:561-498-4440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA061491002085R0202X
FL1014902085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL149MPOtherBCBS
FL002555400Medicaid
FL149MPOtherBCBS