Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 4301064665 | MI |
N | 111NI0900X | Internist | 4301064665 | MI |
N | 207RG0300X | Geriatric Medicine | 4301064665 | MI |
Y | 207RH0002X | Hospice and Palliative Medicine | 4301064665 | MI |
NPI | 1285643817 |
---|---|
Provider Name | Darrell Wayne Craig |
First Address | Ypsilanti, MI 48197-1051 |
Second Address | Ann Arbor, MI 48105-9484 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2006 |
Last Update Date | 23/06/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3103100 | (05) | MI |
A08677 | (02) | MI |