Individual
CRAIG K. MATHESON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
821 W US HIGHWAY 10, SCOTTVILLE, MI 49454-9601
(231) 757-2500
(231) 757-9073
Mailing address
821 W US HIGHWAY 10, SCOTTVILLE, MI 49454-9601
(231) 757-2500
(231) 757-9073
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
5101011416
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0855301234
BLUE CROSS BLUE SHIELD ID
MI
01
—
23D1038209
CLIA
MI
05
—
4615194
—
MI
Enumeration date
10/11/2005
Last updated
02/12/2021
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