Provider Demographics
NPI:1154580116
Name:CROWE, BRIAN TODD (SAC)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:TODD
Last Name:CROWE
Suffix:
Gender:M
Credentials:SAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14970 N 2900 EAST RD
Mailing Address - Street 2:
Mailing Address - City:SAUNEMIN
Mailing Address - State:IL
Mailing Address - Zip Code:61769-6079
Mailing Address - Country:US
Mailing Address - Phone:815-990-9525
Mailing Address - Fax:
Practice Address - Street 1:14970 N 2900 EAST RD
Practice Address - Street 2:
Practice Address - City:SAUNEMIN
Practice Address - State:IL
Practice Address - Zip Code:61769-6079
Practice Address - Country:US
Practice Address - Phone:815-990-9525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-05
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical