Provider Demographics
NPI:1790703429
Name:CRABTREE, TRAVES DEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:TRAVES
Middle Name:DEAN
Last Name:CRABTREE
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 1:315 W CARPENTER ST
Mailing Address - Street 2:PO BOX 19677
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62794-9677
Mailing Address - Country:US
Mailing Address - Phone:217-545-8000
Mailing Address - Fax:217-545-7053
Practice Address - Street 1:315 W CARPENTER ST
Practice Address - Street 2:2ND FLOOR CLINIC C
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62702-4901
Practice Address - Country:US
Practice Address - Phone:217-545-8000
Practice Address - Fax:217-545-7053
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036112228208G00000X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO919620412Medicaid
MO919620412Medicaid
MO919620412Medicaid
MO919623744Medicare PIN
ILF400341102Medicare PIN
IL$$$$$$$$$Medicaid