Provider Demographics
NPI:1962389569
Name:KLEIKAMP, CRAIG ANTHONY
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:ANTHONY
Last Name:KLEIKAMP
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W1798 COUNTY ROAD 374
Mailing Address - Street 2:
Mailing Address - City:CARNEY
Mailing Address - State:MI
Mailing Address - Zip Code:49812-9322
Mailing Address - Country:US
Mailing Address - Phone:906-235-9489
Mailing Address - Fax:
Practice Address - Street 1:226 S CEDAR ST
Practice Address - Street 2:
Practice Address - City:MANISTIQUE
Practice Address - State:MI
Practice Address - Zip Code:49854-1426
Practice Address - Country:US
Practice Address - Phone:906-235-9489
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-18
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704343922163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse