Provider Demographics
NPI:1821536574
Name:COLE, CRAIG (CST, KCSA)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:
Last Name:COLE
Suffix:
Gender:M
Credentials:CST, KCSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 SOMERSET CT
Mailing Address - Street 2:
Mailing Address - City:SELLERSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47172-2811
Mailing Address - Country:US
Mailing Address - Phone:812-566-1272
Mailing Address - Fax:
Practice Address - Street 1:901 SOMERSET CT
Practice Address - Street 2:
Practice Address - City:SELLERSBURG
Practice Address - State:IN
Practice Address - Zip Code:47172-2811
Practice Address - Country:US
Practice Address - Phone:812-566-1272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-02
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYSA301246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant