Provider Demographics
NPI:1922328418
Name:ROELKE, CRAIG THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:THOMAS
Last Name:ROELKE
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 1:161 19TH ST S STE 106
Mailing Address - Street 2:
Mailing Address - City:SARTELL
Mailing Address - State:MN
Mailing Address - Zip Code:56377-2555
Mailing Address - Country:US
Mailing Address - Phone:320-252-3376
Mailing Address - Fax:218-898-7597
Practice Address - Street 1:161 19TH ST S STE 106
Practice Address - Street 2:
Practice Address - City:SARTELL
Practice Address - State:MN
Practice Address - Zip Code:56377-2555
Practice Address - Country:US
Practice Address - Phone:320-252-3376
Practice Address - Fax:218-898-7597
Is Sole Proprietor?:No
Enumeration Date:2010-06-07
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN54575207N00000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNP01075998OtherRAILROAD MEDICARE
MNP01075998OtherRAILROAD MEDICARE