Individual
DR. CRAIG J EVERINGHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
12100 S HURON RIVER DR, ROMULUS, MI 48174-1119
(734) 941-1070
(734) 941-1763
Mailing address
26901 BEAUMONT BLVD STE 3D, SOUTHFIELD, MI 48033-3849
(947) 522-1863
(947) 522-0307
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
381898373
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1290362 TYPE 11
—
MI
01
—
5820103
BLUE CROSS BLUE SHIELD
MI
Enumeration date
08/09/2005
Last updated
10/22/2020
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