Provider Demographics
NPI:1467450551
Name:PILICHOWSKI, CRAIG J (DPM)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:J
Last Name:PILICHOWSKI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 LONG RAPIDS PLZ
Mailing Address - Street 2:
Mailing Address - City:ALPENA
Mailing Address - State:MI
Mailing Address - Zip Code:49707-1375
Mailing Address - Country:US
Mailing Address - Phone:989-354-3309
Mailing Address - Fax:989-354-9190
Practice Address - Street 1:321 LONG RAPIDS PLZ
Practice Address - Street 2:
Practice Address - City:ALPENA
Practice Address - State:MI
Practice Address - Zip Code:49707-1375
Practice Address - Country:US
Practice Address - Phone:989-354-3309
Practice Address - Fax:989-354-9190
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001908213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4271530Medicaid
MICP001908OtherMICHIGAN LICENSE NUMBER
MI4271530Medicaid
MI0N21940001Medicare ID - Type Unspecified