Provider Demographics
NPI:1962821751
Name:CRAIG KUESEL DO PLLC
Entity Type:Organization
Organization Name:CRAIG KUESEL DO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ DO
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:T
Authorized Official - Last Name:KUESEL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:231-935-9700
Mailing Address - Street 1:3537 W FRONT ST
Mailing Address - Street 2:STE A
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-7941
Mailing Address - Country:US
Mailing Address - Phone:231-935-9700
Mailing Address - Fax:231-935-9706
Practice Address - Street 1:3537 W FRONT ST
Practice Address - Street 2:STE A
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-7941
Practice Address - Country:US
Practice Address - Phone:231-935-9700
Practice Address - Fax:231-935-9706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-09
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI51010091052084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty