Individual
MR. CRAIG BERRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
920 LAMPLIGHTER LN, GRAFTON, WI 53024-9314
(262) 573-1657
Mailing address
920 LAMPLIGHTER LN, GRAFTON, WI 53024-9314
(262) 573-1657
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
41733700
WI
332BX2000X
Oxygen Equipment & Supplies (DME)
41733700
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41733700
—
WI
Enumeration date
12/01/2009
Last updated
12/01/2009
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