Provider Demographics
NPI:1124043252
Name:BACKS, CRAIG A (MD)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:A
Last Name:BACKS
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 1:2921 GREENBRIAR DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-6421
Mailing Address - Country:US
Mailing Address - Phone:217-321-1987
Mailing Address - Fax:866-594-7830
Practice Address - Street 1:2921 GREENBRIAR DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-6421
Practice Address - Country:US
Practice Address - Phone:217-321-1987
Practice Address - Fax:866-594-7830
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036065128207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL008546OtherHEALTH ALLIANCE
IL020057300OtherBLACK LUNG
IL100364OtherHEALTHLINK
IL6394POtherCATERPILLAR
IL036065128Medicaid
IL110201127OtherRR MEDICARE PIN
IL133586700OtherACS-OWCP
IL08421024OtherBLUE CROSS BLUE SHIELD
IL14D0949277OtherCLIA CERT
ILCD7143OtherRR MEDICARE GRP
IL170765OtherPERSONAL CARE
ILCD7143OtherRR MEDICARE GRP
ILL77118Medicare PIN
IL133586700OtherACS-OWCP
IL6394POtherCATERPILLAR
IL100364OtherHEALTHLINK