Provider Demographics
NPI:1316923428
Name:CRAVEN, EDWARD E (MD)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:E
Last Name:CRAVEN
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 1:805 S OAKLAND ST
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:MI
Mailing Address - Zip Code:48879-2253
Mailing Address - Country:US
Mailing Address - Phone:989-227-3358
Mailing Address - Fax:989-227-3349
Practice Address - Street 1:805 S OAKLAND ST
Practice Address - Street 2:
Practice Address - City:SAINT JOHNS
Practice Address - State:MI
Practice Address - Zip Code:48879-2253
Practice Address - Country:US
Practice Address - Phone:989-227-3358
Practice Address - Fax:989-227-3349
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301085500207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2341193Medicaid
OHCR4093961Medicare ID - Type Unspecified
OH2341193Medicaid