Provider Demographics
NPI:1194725077
Name:RAYCRAFT, EDMUND WILLIAM (MD)
Entity type:Individual
Prefix:DR
First Name:EDMUND
Middle Name:WILLIAM
Last Name:RAYCRAFT
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 1:304 W HAY ST
Mailing Address - Street 2:SUITE 111
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526-6328
Mailing Address - Country:US
Mailing Address - Phone:217-872-8200
Mailing Address - Fax:217-872-4898
Practice Address - Street 1:304 W HAY ST
Practice Address - Street 2:SUITE 111
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-6328
Practice Address - Country:US
Practice Address - Phone:217-872-8200
Practice Address - Fax:217-872-4898
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036079689207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL131595OtherHEALTHLINK
IL036079689Medicaid
ILP00273351OtherRAILROAD MEDICARE
IL005832071OtherBLUE CROSS BLUE SHIELD
IL5574560001OtherMEDICARE DME
ILP00273351OtherRAILROAD MEDICARE
IL131595OtherHEALTHLINK