Provider Demographics
NPI:1487865788
Name:MADHAV CRAWFORD, TARUNA (MD)
Entity Type:Individual
Prefix:DR
First Name:TARUNA
Middle Name:
Last Name:MADHAV CRAWFORD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:TARUNA
Other - Middle Name:JETHANAND
Other - Last Name:MADHAV
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:401 N WALL ST STE 208
Mailing Address - Street 2:
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-2949
Mailing Address - Country:US
Mailing Address - Phone:815-935-7256
Mailing Address - Fax:815-935-7064
Practice Address - Street 1:400 RIVERSIDE DR STE 1600
Practice Address - Street 2:
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914
Practice Address - Country:US
Practice Address - Phone:815-802-7090
Practice Address - Fax:815-802-7091
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.125017207X00000X, 207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL5519005Medicare PIN
ILIL5520005Medicare PIN