Provider Demographics
NPI:1952456816
Name:CRAIG, KEVIN J (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:J
Last Name:CRAIG
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 1:11607 N SPARROW LN
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN HILLS
Mailing Address - State:AZ
Mailing Address - Zip Code:85268-5045
Mailing Address - Country:US
Mailing Address - Phone:517-402-5811
Mailing Address - Fax:480-718-7651
Practice Address - Street 1:11607 N SPARROW LN
Practice Address - Street 2:
Practice Address - City:FOUNTAIN HILLS
Practice Address - State:AZ
Practice Address - Zip Code:85268-5045
Practice Address - Country:US
Practice Address - Phone:517-402-5811
Practice Address - Fax:480-718-7651
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301072786174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI383694638OtherTAX ID
MI4625913Medicaid
MI4625913Medicaid
MI383694638OtherTAX ID