Healthcare Provider Details

I. General information

NPI: 1639308737
Provider Name (Legal Business Name): ABENA KROW-GOOSSEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ABENA KROW-RODNEY

II. Dates (important events)

Enumeration Date: 07/09/2009
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 W WALNUT ST
CANTON IL
61520-2497
US

IV. Provider business mailing address

210 W WALNUT ST
CANTON IL
61520-2497
US

V. Phone/Fax

Practice location:
  • Phone: 309-647-5240
  • Fax:
Mailing address:
  • Phone: 309-647-5240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036149578
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number40180
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR1803
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036149578
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036149578
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: