Provider Demographics
NPI:1073509824
Name:CRABB, JEREMIAH EDWARD VI (MD)
Entity Type:Individual
Prefix:
First Name:JEREMIAH
Middle Name:EDWARD
Last Name:CRABB
Suffix:VI
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 1:1001 MAIN ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61606-1907
Mailing Address - Country:US
Mailing Address - Phone:309-672-5682
Mailing Address - Fax:309-672-3147
Practice Address - Street 1:1001 MAIN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61606-1907
Practice Address - Country:US
Practice Address - Phone:309-672-5682
Practice Address - Fax:309-672-3147
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036074455207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036074455Medicaid
ILP04379Medicare PIN
C39955Medicare UPIN