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General NPI Number Information
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NPI Number | 1154580116
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Entity Type | Individual
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Provider Name | BRIAN TODD CROWE SAC
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Gender | Male
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Dates
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Enumeration Date | 06/05/2008
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Last Update Date | 10/19/2022
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Provider Practice Location Address
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Address Line | 14970 N 2900 EAST RD
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City | SAUNEMIN
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State | IL
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Zip | 61769-6079
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Country | US
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Telephone | 815-990-9525
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Fax |
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Provider Business Mailing Address
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Address Line | 14970 N 2900 EAST RD
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City | SAUNEMIN
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State | IL
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Zip | 61769-6079
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Country | US
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Telephone | 815-990-9525
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State |
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