Individual
CRAIG JON VINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2550 UNIVERSITY AVENUE WEST, SUITE 229N, ST PAUL, MN 55114
(651) 645-3115
(651) 645-2752
Mailing address
2550 UNIVERSITY AVENUE WEST, SUITE 229N, ST PAUL, MN 55114
(651) 645-3115
(651) 645-2752
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
33712
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1530494
MEDICA
MN
01
—
317T6VI
BCBS OF MN
MN
05
—
786505800
—
MN
Enumeration date
01/06/2006
Last updated
02/10/2013
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