Provider Demographics
NPI:1013925080
Name:KUESEL, CRAIG THOMAS (DO)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:THOMAS
Last Name:KUESEL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1105 SIXTH ST
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-2345
Mailing Address - Country:US
Mailing Address - Phone:231-935-5000
Mailing Address - Fax:231-935-5588
Practice Address - Street 1:3922 CEDAR RUN RD
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-9687
Practice Address - Country:US
Practice Address - Phone:231-392-0430
Practice Address - Fax:231-935-3438
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI51010091052084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI114231632Medicaid
5702277Medicare ID - Type Unspecified
MI114231632Medicaid