Provider Demographics
NPI:1811979826
Name:CRAGG, DAVID R (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:R
Last Name:CRAGG
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 1:4600 INVESTMENT DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48098-6365
Mailing Address - Country:US
Mailing Address - Phone:248-267-5050
Mailing Address - Fax:248-267-5051
Practice Address - Street 1:4600 INVESTMENT DR
Practice Address - Street 2:SUITE 200
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48098-6365
Practice Address - Country:US
Practice Address - Phone:248-267-5050
Practice Address - Fax:248-267-5051
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301050248207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI00631EOtherHEALTH ALLIANCE PLAN
MI2798550Medicaid
MI0606317371OtherBLUE CROSS BLUE SHIELD OF MI
MI060018401OtherMEDICARE RAILROAD
MI0F37214004Medicare PIN
MI0606317371OtherBLUE CROSS BLUE SHIELD OF MI