Provider Demographics
NPI:1730186321
Name:PLATTNER, CRAIG ANTHONY (CO)
Entity type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:ANTHONY
Last Name:PLATTNER
Suffix:
Gender:M
Credentials:CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 W ROMEO B GARRETT AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61605-2535
Mailing Address - Country:US
Mailing Address - Phone:309-682-1382
Mailing Address - Fax:309-682-7125
Practice Address - Street 1:311 W ROMEO B GARRETT AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61605-2535
Practice Address - Country:US
Practice Address - Phone:309-682-1382
Practice Address - Fax:309-682-7125
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist