Provider Demographics
NPI:1699873117
Name:SVOBODA, CRAIG V (MD)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:V
Last Name:SVOBODA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 155
Mailing Address - Street 2:REA CINIC
Mailing Address - City:CHRISTOPHER
Mailing Address - State:IL
Mailing Address - Zip Code:62822
Mailing Address - Country:US
Mailing Address - Phone:618-724-2401
Mailing Address - Fax:618-724-4628
Practice Address - Street 1:607 4TH ST
Practice Address - Street 2:ELDORADO RURAL HEALTH CLINIC
Practice Address - City:ELDORADO
Practice Address - State:IL
Practice Address - Zip Code:62930
Practice Address - Country:US
Practice Address - Phone:618-273-2951
Practice Address - Fax:618-273-2712
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036076253207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036076253Medicaid
IL036076253Medicaid
E18990Medicare ID - Type Unspecified