Provider Demographics
NPI:1194725341
Name:CRAWFORD, SUSAN E (DO)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:E
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:TERESA CAMP, NORTHWESTERN FACULTY FDN, PROV ENROLLMENT
Mailing Address - Street 2:680 LAKESHORE DRIVE, SUITE #1000
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611
Mailing Address - Country:US
Mailing Address - Phone:314-977-4559
Mailing Address - Fax:
Practice Address - Street 1:TERESA CAMP, NORTHWESTERN FACULTY FDN, PROV ENROLLMENT
Practice Address - Street 2:680 LAKESHORE DRIVE, SUITE #1000
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611
Practice Address - Country:US
Practice Address - Phone:314-977-4559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036079326207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036079326Medicaid
IL036079326Medicaid