Provider Demographics
NPI:1538188818
Name:CRABTREE, JAMES T (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:T
Last Name:CRABTREE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:125 E PLUMMER BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62629-8136
Mailing Address - Country:US
Mailing Address - Phone:217-483-3333
Mailing Address - Fax:217-483-4393
Practice Address - Street 1:125 E PLUMMER BLVD STE A
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:IL
Practice Address - Zip Code:62629-8136
Practice Address - Country:US
Practice Address - Phone:217-483-3333
Practice Address - Fax:217-483-4393
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036061323207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL14D0435365OtherCLIA CERT
ILP00149042OtherRR MEDICARE PIN
IL020057300OtherBLACK LUNG
ILCD7143OtherRR MEDICARE GRP
IL036061323Medicaid
IL6394POtherCATERPILLAR
IL008538OtherHEALTH ALLIANCE
IL133586700OtherACS-OWCP
IL08421024OtherBLUE CROSS BLUE SHIELD
IL131767OtherHEALTHLINK
IL222689OtherPERSONAL CARE
IL222689OtherPERSONAL CARE