Provider Demographics
NPI:1861923914
Name:CRANER, DOMENIC (MD)
Entity type:Individual
Prefix:
First Name:DOMENIC
Middle Name:
Last Name:CRANER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 AUDUBON PLAZA DR STE 230
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40217-1319
Mailing Address - Country:US
Mailing Address - Phone:502-637-3311
Mailing Address - Fax:502-637-3168
Practice Address - Street 1:3 AUDUBON PLAZA DR STE LL2
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40217-1360
Practice Address - Country:US
Practice Address - Phone:502-636-4940
Practice Address - Fax:502-636-4941
Is Sole Proprietor?:No
Enumeration Date:2017-03-21
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY569382084N0400X
TN390200000X
KYTP898208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program