Provider Demographics
NPI:1023054681
Name:CRABB, KENNETH (MD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:
Last Name:CRABB
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 1:280 SMITH AVE. NORTH
Mailing Address - Street 2:SUITE 460
Mailing Address - City:ST. PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-2437
Mailing Address - Country:US
Mailing Address - Phone:651-224-4897
Mailing Address - Fax:651-297-6559
Practice Address - Street 1:280 SMITH AVE. NORTH
Practice Address - Street 2:SUITE 460
Practice Address - City:ST. PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2437
Practice Address - Country:US
Practice Address - Phone:651-224-4897
Practice Address - Fax:651-297-6559
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN22756174400000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN100613OtherUCARE
MN675593300Medicaid
MN00010438OtherPREFERRED ONE
MN21593CROtherBLUE SHIELD
MN07-29530OtherMEDICA
MNHP20169OtherHEALTH PARTNERS
MN07-29530OtherMEDICA