Provider Demographics
NPI:1912989716
Name:CRAIG, EARL J (MD)
Entity Type:Individual
Prefix:DR
First Name:EARL
Middle Name:J
Last Name:CRAIG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6330 E 75TH STREET
Mailing Address - Street 2:SUITE 110
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2717
Mailing Address - Country:US
Mailing Address - Phone:317-588-7130
Mailing Address - Fax:317-588-7150
Practice Address - Street 1:717 S ROGERS ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-2335
Practice Address - Country:US
Practice Address - Phone:812-337-0700
Practice Address - Fax:812-337-0714
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2020-10-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01041874208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200096010Medicaid
IN899980CMedicare PIN
IN200096010Medicaid