Provider Demographics
NPI:1336168699
Name:CRABTREE, CATHERINE (MD)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:CRABTREE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62629-1702
Mailing Address - Country:US
Mailing Address - Phone:217-483-3333
Mailing Address - Fax:217-483-4393
Practice Address - Street 1:345 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:IL
Practice Address - Zip Code:62629-1702
Practice Address - Country:US
Practice Address - Phone:217-483-3333
Practice Address - Fax:217-483-4393
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036061599207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILCD7143OtherRR MEDICARE GRP
IL14D0435365OtherCLIA CERT
IL075301OtherHEALTH ALLIANCE
IL6394POtherCATERPILLAR
IL020057300OtherBLACK LUNG
IL133586700OtherACS-OWCP
IL036061599Medicaid
IL222674OtherPERSONAL CARE
IL466639OtherHEALTHLINK
ILP00174614OtherRR MEDICARE PIN
IL08421024OtherBLUE CROSS BLUE SHIELD
IL14D0435365OtherCLIA CERT