Healthcare Provider Details

I. General information

NPI: 1124616321
Provider Name (Legal Business Name): COURTNEY ANN CROWE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2021
Last Update Date: 09/07/2022
Certification Date: 08/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 S CALIFORNIA AVE
CHICAGO IL
60608-1732
US

IV. Provider business mailing address

26460 NETWORK PL
CHICAGO IL
60673-9591
US

V. Phone/Fax

Practice location:
  • Phone: 773-257-6665
  • Fax:
Mailing address:
  • Phone: 773-257-2820
  • Fax: 773-762-8529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number085.009011
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085009011
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: