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General NPI Number Information
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NPI Number | 1508031295
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Entity Type | Organization
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Legal Business Name | CRAWFORD SURGICARE
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Dates
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Enumeration Date | 04/24/2008
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Last Update Date | 04/24/2008
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Provider Practice Location Address
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Address Line | 6441 S PULASKI RD
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City | CHICAGO
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State | IL
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Zip | 60629-5148
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Country | US
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Telephone | 773-582-7100
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Fax | 773-561-1111
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Provider Business Mailing Address
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Address Line | 6441 S PULASKI RD
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City | CHICAGO
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State | IL
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Zip | 60629-5148
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Country | US
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Telephone | 773-582-7100
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Fax | 773-561-1111
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. WALTER JACOBSEN
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Credential | DPM
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Telephone | 773-582-7100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP1100X
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Taxonomy Name | Podiatric Clinic/Center
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License Number | 016004485
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License Number State | IL
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