Provider Demographics
NPI:1730242033
Name:HANSEN, CRAIG K (MD)
Entity type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:K
Last Name:HANSEN
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 1:2620 JACKSON BLVD
Mailing Address - Street 2:#C
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-3478
Mailing Address - Country:US
Mailing Address - Phone:605-341-1208
Mailing Address - Fax:605-341-3552
Practice Address - Street 1:2620 JACKSON BLVD
Practice Address - Street 2:#C
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-3478
Practice Address - Country:US
Practice Address - Phone:605-341-1208
Practice Address - Fax:605-341-3552
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD2541207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5601950Medicaid
SD0001972OtherWELLMARK BLUE CROSS
SDS9222Medicare PIN
SD0001972OtherWELLMARK BLUE CROSS