Samuel W Criswell, DPM
Individual provider Active NPI Podiatrist · Grand Forks, ND
NPI 1114018223 · NPPES record last updated Oct 25, 2007
Key facts
- NPI
- 1114018223
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Podiatrist 213E00000X
- License
- 28 (ND)
- Practice address
- 1000 S Columbia Rd
Grand Forks, ND 58201-4032 - Phone
- (701) 780-6000
- NPI assigned
- Sep 27, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28 | ND | MD | Podiatrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Clinic Pharmacy Inc | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Podiatrist | 213E00000X | 28 | ND | Yes |
Addresses
Primary practice location
1000 S Columbia Rd
Grand Forks, ND 58201-4032
Mailing address
PO Box 6002
Grand Forks, ND 58206-6002
Phone (701) 780-5000
Other providers in Grand Forks, ND
- Courageous Connections
- Meaghan Rene Coval
- Cheryl A Cox
- Guadalupe Crawford
- John Crist
- Crossover Health Medical Group
- Summer Crow
- Cheryl Cruikshank
- Rachel Marie Cummings
- Jessica Maria Cunniff Darcy
All providers in Grand Forks, ND · Podiatrist in North Dakota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 25, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.