Provider Demographics
NPI:1386814457
Name:CRAIG, KETURAH (DPM)
Entity type:Individual
Prefix:
First Name:KETURAH
Middle Name:
Last Name:CRAIG
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 661495
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35266-1495
Mailing Address - Country:US
Mailing Address - Phone:205-979-5882
Mailing Address - Fax:205-979-1248
Practice Address - Street 1:507 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:AL
Practice Address - Zip Code:36748-2025
Practice Address - Country:US
Practice Address - Phone:334-578-2357
Practice Address - Fax:334-295-5596
Is Sole Proprietor?:No
Enumeration Date:2008-03-05
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL291213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1386814457Medicaid
AL113458Medicaid
AL113459Medicaid
AL515-47487OtherBC BS OF AL
AL515-47481OtherBC BS OF ALABAMA
AL515-47484OtherBC BS OFAL
AL510-49800OtherBC BS OF AL
AL510-49801OtherBC BS OF AL
AL6931751OtherCIGNA
AL9509124OtherAETNA
AL113460Medicaid
AL510-49799OtherBC BS OF AL
AL510I480009Medicare PIN
AL113458Medicaid