Provider Demographics
NPI:1144280413
Name:MAGNATTA, CRAIG (DO)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:
Last Name:MAGNATTA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3950 S ROCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-5160
Mailing Address - Country:US
Mailing Address - Phone:248-844-6000
Mailing Address - Fax:248-844-6159
Practice Address - Street 1:3950 S ROCHESTER RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-5160
Practice Address - Country:US
Practice Address - Phone:248-844-6000
Practice Address - Fax:248-844-6159
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101007450207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOF31339OtherBCBS
MI2582460Medicaid
MI2582460Medicaid
MIE49723Medicare UPIN