Provider Demographics
NPI:1235421603
Name:CRAIG A BACKS MD LLC
Entity Type:Organization
Organization Name:CRAIG A BACKS MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:BACKS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:217-321-1987
Mailing Address - Street 1:2921 GREENBRIAR DR
Mailing Address - Street 2:SUITE C
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:SUITE C
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-04
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL248000028207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty