Individual
DR. CRAIG KENNETH HALLSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
2080P0203X
Pediatric Critical Care Medicine Physician
Primary
18514
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07076371
—
MS
05
—
157470
—
AL
05
—
1603767
—
LA
01
—
512I370060
MEDICARE PTAN
MS
Enumeration date
06/16/2006
Last updated
04/01/2014
Update your record
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