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General NPI Number Information
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NPI Number | 1508927245
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Entity Type | Organization
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Legal Business Name | PHILIP A. CROOKE, M.D., P.C.
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Dates
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Enumeration Date | 12/13/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 648 S WALKER ST
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City | BLOOMINGTON
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State | IN
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Zip | 47403-2158
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Country | US
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Telephone | 812-331-1810
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Fax | 812-331-1714
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Provider Business Mailing Address
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Address Line | 648 S WALKER ST
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City | BLOOMINGTON
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State | IN
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Zip | 47403-2158
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Country | US
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Telephone | 812-331-1810
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Fax | 812-331-1714
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MS. RHEA DAWN BUSKIRK
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Credential | CMM
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Telephone | 812-331-1810
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 1024945
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License Number State | IN
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