Craig, Russell Wayne

Craig, Russell Wayne is an individual health care provider with primary practice located at 17901 Hall Rd , Macomb Twp MI 48044. He recently has only one registered license in Allopathic & Osteopathic Physicians / Otolaryngology/Facial Plastic Surgery, which is considered as his primary health care specialty. Craig, Russell Wayne can be contacted via phone (586) 412-0900.

Contact Information

Primary practice address
17901 Hall Rd Macomb Twp MI 48044
Phone: (586) 412-0900
Fax: (586) 412-9767
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Otolaryngology/Facial Plastic Surgery 207YX0905X 5101011400 Michigan

Profile Details

NPI number 1508979436
LBN Legal business name Craig, Russell Wayne
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 16th, 2006
Last updated Jan 14th, 2010 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1508979436 NPPES
Michigan Other 5500330 BCBS OF MI
Michigan MEDICAID 3385222 BCBS OF MI

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