Provider Demographics
NPI:1043574247
Name:CRABTREE, BENJAMIN THOMAS
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:THOMAS
Last Name:CRABTREE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:749 W CALIFORNIA TER # 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-4516
Mailing Address - Country:US
Mailing Address - Phone:773-793-6223
Mailing Address - Fax:773-345-4630
Practice Address - Street 1:749 W CALIFORNIA TER # 1
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-4516
Practice Address - Country:US
Practice Address - Phone:773-793-6223
Practice Address - Fax:773-345-4630
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-02
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist