Healthcare Provider Details

I. General information

NPI: 1487865788
Provider Name (Legal Business Name): TARUNA MADHAV CRAWFORD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TARUNA JETHANAND MADHAV M.D.

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 03/29/2021
Certification Date: 03/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 RIVERSIDE DR STE 1600
BOURBONNAIS IL
60914
US

IV. Provider business mailing address

401 N WALL ST STE 208
KANKAKEE IL
60901-2949
US

V. Phone/Fax

Practice location:
  • Phone: 815-802-7090
  • Fax: 815-802-7091
Mailing address:
  • Phone: 815-935-7256
  • Fax: 815-935-7064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number036.125017
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number036.125017
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: