Provider Demographics
NPI:1912947151
Name:CRAIG, MARVIN D (MD PC)
Entity type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:D
Last Name:CRAIG
Suffix:
Gender:M
Credentials:MD PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4220 LUNA PIER RD
Mailing Address - Street 2:
Mailing Address - City:LUNA PIER
Mailing Address - State:MI
Mailing Address - Zip Code:48157-9796
Mailing Address - Country:US
Mailing Address - Phone:734-317-7474
Mailing Address - Fax:734-317-7476
Practice Address - Street 1:4220 LUNA PIER RD
Practice Address - Street 2:
Practice Address - City:LUNA PIER
Practice Address - State:MI
Practice Address - Zip Code:48157-9796
Practice Address - Country:US
Practice Address - Phone:734-243-9400
Practice Address - Fax:734-317-7476
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301053651207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI383124723OtherTAX ID
MI1921621Medicaid
MI0N19820Medicare PIN
MIA16451Medicare UPIN
MIA16451Medicare UPIN