Provider Demographics
NPI:1033195383
Name:CRANDALL, DAVID J (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
Last Name:CRANDALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22N285 PEPPER RD
Mailing Address - Street 2:SUITE #111
Mailing Address - City:LAKE BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-5982
Mailing Address - Country:US
Mailing Address - Phone:847-382-7330
Mailing Address - Fax:847-382-9654
Practice Address - Street 1:22N285 PEPPER RD
Practice Address - Street 2:SUITE #111
Practice Address - City:LAKE BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-5982
Practice Address - Country:US
Practice Address - Phone:847-382-7330
Practice Address - Fax:847-382-9654
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-078801207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036078801OtherBLUE CROSS BLUE SHIELD
IL036078801Medicaid
IL50703OtherADVOCATE PHO
IL160019098OtherRAILROAD MEDICARE
ILK09642Medicare ID - Type Unspecified
IL036078801Medicaid
IL036078801OtherBLUE CROSS BLUE SHIELD