Basic Information
Provider Information | |||||||||
NPI: | 1316989882 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | KUHLMANN | ||||||||
FirstName: | CRAIG | ||||||||
MiddleName: | F | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 6001 | ||||||||
Address2: |   | ||||||||
City: | FARGO | ||||||||
State: | ND | ||||||||
PostalCode: | 581086001 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7013643300 | ||||||||
FaxNumber: | 7013648906 | ||||||||
Practice Location | |||||||||
Address1: | 1401 13TH AVE E | ||||||||
Address2: |   | ||||||||
City: | WEST FARGO | ||||||||
State: | ND | ||||||||
PostalCode: | 580783468 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7013645751 | ||||||||
FaxNumber: | 7013645750 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/11/2006 | ||||||||
LastUpdateDate: | 04/16/2012 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 5498 | ND | Y |   | Allopathic & Osteopathic Physicians | Family Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 4F421KU | 01 | ND | MNBS-MHD # | OTHER | 4F423KU | 01 | ND | MNBS-NP # | OTHER | DA9010896150 | 01 | ND | PREF 1 # | OTHER | 0106122 | 01 | ND | MEDICA-WA # | OTHER | 676624 | 01 | ND | ARAZ | OTHER | HP19532 | 01 | ND | HEALTHPARTNERS # | OTHER | 4F422KU | 01 | ND | MNBS-FGO # | OTHER | 0106120 | 01 | ND | MEDICA-NP # | OTHER | 0108122 | 01 | ND | MEDICA-INN # | OTHER | 0108123 | 01 | ND | MEDICA-FGO # | OTHER | 11185 | 01 | ND | NDBS # | OTHER | 142025 | 01 | ND | UCARE # | OTHER | 15740 | 05 | ND |   | MEDICAID | 0114540 | 01 | ND | MEDICA-MHD # | OTHER | 4F424KU | 01 | ND | MNBS-WA # | OTHER | 561888600 | 05 | ND |   | MEDICAID |