Provider Demographics
NPI:1700993052
Name:MCMANAMAN, CRAIG J (DO PLLC)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:J
Last Name:MCMANAMAN
Suffix:
Gender:M
Credentials:DO PLLC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1011 S VAN DYKE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:BAD AXE
Mailing Address - State:MI
Mailing Address - Zip Code:48413
Mailing Address - Country:US
Mailing Address - Phone:989-269-5015
Mailing Address - Fax:989-269-6601
Practice Address - Street 1:1011 S VAN DYKE RD
Practice Address - Street 2:SUITE A
Practice Address - City:BAD AXE
Practice Address - State:MI
Practice Address - Zip Code:48413
Practice Address - Country:US
Practice Address - Phone:989-269-5015
Practice Address - Fax:989-269-6601
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2009-12-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MICM012814207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2053200055OtherBCBS
MI4238787Medicaid
C26008059Medicare ID - Type Unspecified
MI4238787Medicaid