Individual
CRAIG MICHELSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3524 E MILWAUKEE ST, JANESVILLE, WI 53546-1626
(608) 756-7100
(608) 756-4700
Mailing address
1891 COLBY LN, LOVES PARK, IL 61111-4381
(815) 494-8893
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
28265
WI
207Q00000X
Family Medicine Physician
36071282
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MICHECRA
MERCYCARE INSURANCE
WI
Enumeration date
12/29/2005
Last updated
11/15/2011
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