Individual
MR. CRAIG K. HANSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2620 JACKSON BLVD, #C, RAPID CITY, SD 57702-3478
(605) 341-1208
(605) 341-3552
Mailing address
2620 JACKSON BLVD, #C, RAPID CITY, SD 57702-3478
(605) 341-1208
(605) 341-3552
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2541
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001972
WELLMARK BLUE CROSS
SD
05
—
5601950
—
SD
Enumeration date
12/18/2006
Last updated
03/14/2011
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