1407816036 NPI number — DR. ADAM G CRANE PSYD

Table of content: DR. ADAM G CRANE PSYD (NPI 1407816036)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407816036 NPI number — DR. ADAM G CRANE PSYD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CRANE
Provider First Name:
ADAM
Provider Middle Name:
G
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSYD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407816036
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1614 W CENTRAL RD
Provider Second Line Business Mailing Address:
SUITE 105
Provider Business Mailing Address City Name:
ARLINGTON HTS
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60005-2490
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-255-9697
Provider Business Mailing Address Fax Number:
847-255-3206

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1614 W CENTRAL RD
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
ARLINGTON HTS
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60005-2490
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-255-9697
Provider Business Practice Location Address Fax Number:
847-255-3206
Provider Enumeration Date:
03/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  071006159 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 071006159 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".




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