Provider Demographics
NPI:1194705947
Name:COCCIA, CRAIG T (MD)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:T
Last Name:COCCIA
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 1:580 W COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:MARQUETTE
Mailing Address - State:MI
Mailing Address - Zip Code:49855-2736
Mailing Address - Country:US
Mailing Address - Phone:615-920-7782
Mailing Address - Fax:906-225-7781
Practice Address - Street 1:580 W COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:MARQUETTE
Practice Address - State:MI
Practice Address - Zip Code:49855-2705
Practice Address - Country:US
Practice Address - Phone:906-225-4575
Practice Address - Fax:906-225-4578
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301407491207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104957388Medicaid
MI104957360Medicaid
MI1405234032OtherBLUE CROSS BLUE SHIELD MI
MI140E210830OtherBLUE CROSS BLUE SHIELD MI
MI104957379Medicaid
MI4264713Medicaid
MI1405234032OtherBLUE CROSS BLUE SHIELD MI
MI104957388Medicaid
MI0P40590002Medicare PIN