Provider Demographics
NPI:1821059791
Name:SANDERS, CRAIG DAVID (DO)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:DAVID
Last Name:SANDERS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:8780 US HIGHWAY 42
Mailing Address - Street 2:STE A
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-6938
Mailing Address - Country:US
Mailing Address - Phone:859-356-6800
Mailing Address - Fax:859-363-4073
Practice Address - Street 1:1974 WALTON NICHOLSON PIKE
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:KY
Practice Address - Zip Code:41051-7906
Practice Address - Country:US
Practice Address - Phone:859-356-6800
Practice Address - Fax:859-363-4073
Is Sole Proprietor?:No
Enumeration Date:2006-03-30
Last Update Date:2020-12-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY02741207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2131704Medicaid
KY64048184Medicaid
KY0364914Medicare PIN
KY080185148Medicare PIN
OH2131704Medicaid