Provider Demographics
NPI:1104938778
Name:MEYER, CRAIG EDWARD (MD)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:EDWARD
Last Name:MEYER
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 1:500 ARCADE AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46514-2477
Mailing Address - Country:US
Mailing Address - Phone:574-389-9696
Mailing Address - Fax:574-389-9797
Practice Address - Street 1:500 ARCADE AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-2477
Practice Address - Country:US
Practice Address - Phone:574-389-9696
Practice Address - Fax:574-389-9797
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01031695A207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN070990Medicare ID - Type Unspecified
INC24670Medicare UPIN