MEDICARE: DAVID C CRABTREE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RP1001X	Pulmonary Disease Physician	036090543	IL
2	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	036090543	IL

General Provider Information

NPI Number	:	1487605291
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID C CRABTREE M.D.

Provider Business Mailing Address
First Line	:	2010 JACOBSSEN DR
Second Line	:
City	:	NORMAL
State	:	IL
Zip	:	61761-6280
Country	:	US
Telephone Number	:	309-452-0995
Fax Number	:	309-862-0961

Provider Business Practice Location Address
First Line	:	2151 W WHITE OAKS DR
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62704-6410
Country	:	US
Telephone Number	:	217-717-4404
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2006
Last Update Date	:	10/18/2022

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