Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 016-005138 | IL |
N | 222Z00000X | Podiatrist | 016-005138 | IL |
Y | 213E00000X | Podiatrist | 06600 | IA |
Y | 222Z00000X | Podiatrist | 06600 | IA |
NPI | 1073512448 |
---|---|
Provider Name | Dr. Steven E Craig |
First Address | Clinton, IA 52733-0523 |
Second Address | Clinton, IA 52732 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2005 |
Last Update Date | 05/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0167403 | (05) | IA |
1073512448 | NPI (01) | IA |
1073512448 | WPS MEDICARE (01) | IL |
1285803452 | ADMINISTAR DME (01) | IL |
1285803452 | DMERC (01) | IA |
421472722 | NONE PROVIDED (01) | |
U69510 | (02) |