Provider Demographics
NPI:1700881059
Name:COLE, CRAIG E (MD)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:E
Last Name:COLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:804 SERVICE RD STE A109F
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48824-7015
Mailing Address - Country:US
Mailing Address - Phone:517-884-2976
Mailing Address - Fax:517-432-3928
Practice Address - Street 1:401 W GREENLAWN AVE
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-2819
Practice Address - Country:US
Practice Address - Phone:517-975-9500
Practice Address - Fax:517-975-9520
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2019-02-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301065532207RH0000X, 207RH0000X, 207RX0202X
WI45346207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34344700Medicaid
H56981Medicare UPIN
WI34344700Medicaid