Provider Demographics
NPI:1447701172
Name:CRAGG, RYAN
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:CRAGG
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 1:540 WARREN AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:MI
Mailing Address - Zip Code:48433-1462
Mailing Address - Country:US
Mailing Address - Phone:810-620-6805
Mailing Address - Fax:
Practice Address - Street 1:540 WARREN AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:MI
Practice Address - Zip Code:48433-1462
Practice Address - Country:US
Practice Address - Phone:810-620-6805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-18
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other