Provider Demographics
NPI:1720046881
Name:CRAIG, KEVIN W (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:W
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:PO BOX 7687
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65205-7687
Mailing Address - Country:US
Mailing Address - Phone:573-882-2259
Mailing Address - Fax:
Practice Address - Street 1:3217 S PROVIDENCE RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-3639
Practice Address - Country:US
Practice Address - Phone:573-884-7733
Practice Address - Fax:573-884-5559
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000160622207QG0300X, 207Q00000X
SC31239207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO103684OtherUNITED HEALTHCARE
MO157694OtherBLUE SHIELD
MO205839905Medicaid
MO480629OtherHEALTHLINK
SCAA37587730OtherMEDICARE
MO157694OtherBLUE CHOICE
MO152360409Medicare UPIN
MO966355236Medicare PIN
MO103684OtherUNITED HEALTHCARE
MO480629OtherHEALTHLINK
MO157694OtherBLUE SHIELD
H61121Medicare UPIN
MO157694OtherBLUE CHOICE