MEDICARE: DR. RICHARD A CRANE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084F0202X	Forensic Psychiatry Physician	036068329	IL

General Provider Information

NPI Number	:	1205013299
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD A CRANE M.D.

Provider Business Mailing Address
First Line	:	3750 N LAKE SHORE DR
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-4238
Country	:	US
Telephone Number	:	773-935-7107
Fax Number	:

Provider Business Practice Location Address
First Line	:	3750 N LAKE SHORE DR
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-4238
Country	:	US
Telephone Number	:	773-935-7107
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/22/2008
Last Update Date	:	01/22/2008

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