Provider Demographics
NPI:1013126432
Name:EARLE-CRUICKSHANKS, GERMAINE (DO)
Entity Type:Individual
Prefix:
First Name:GERMAINE
Middle Name:
Last Name:EARLE-CRUICKSHANKS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2009 N FREMONT ST
Mailing Address - Street 2:#3
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-4311
Mailing Address - Country:US
Mailing Address - Phone:630-667-3926
Mailing Address - Fax:
Practice Address - Street 1:60 HOSPITAL RD
Practice Address - Street 2:HEALTH ALLIANCE HOSPITAL
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-2205
Practice Address - Country:US
Practice Address - Phone:978-466-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036115872207VH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VH0002XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyHospice and Palliative Medicine