| Carlos Crudup, MD | |
|
19310 S Halsted St, Glenwood, IL 60425-1562 | |
| (708) 300-3132 | |
| (708) 300-3149 |
| Full Name | Carlos Crudup |
|---|---|
| Gender | Male |
| Speciality | Family Medicine |
| Location | 19310 S Halsted St, Glenwood, Illinois |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174556484 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 036-112800 (Illinois) | Primary |
| Entity Name | Integrated Rehab Consultants Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1528379195 PECOS PAC ID: 7810184892 Enrollment ID: O20101203000704 |
| Entity Name | Pmr Illinois Holding Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1770038671 PECOS PAC ID: 2062804909 Enrollment ID: O20220126001647 |
| Mailing Address | Practice Location Address |
|---|---|
| Carlos Crudup, MD 19310 S Halsted St, Glenwood, IL 60425-1562 Ph: (708) 300-3132 | Carlos Crudup, MD 19310 S Halsted St, Glenwood, IL 60425-1562 Ph: (708) 300-3132 |
Dr. Michael Louis Radzienda, M.D. Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 19310 S Halsted St, Glenwood, IL 60425 Phone: 708-300-3132 Fax: 773-790-4034 | |
Mohammed Adnan Khaleeluddin, D.O. Family Medicine Medicare: Medicare Enrolled Practice Location: 19310 S Halsted St, Glenwood, IL 60425 Phone: 708-300-3132 Fax: 708-300-3149 | |
Richard Phillips, MD Family Medicine Medicare: Medicare Enrolled Practice Location: 19310 S Halsted St, Glenwood, IL 60425 Phone: 708-300-3132 | |
Katrice Marie Brooks, M.D. Family Medicine Medicare: Accepting Medicare Assignments Practice Location: 19310 S Halsted St, Glenwood, IL 60425 Phone: 708-300-3132 Fax: 773-790-4034 | |
Dr. Michelle Meeks, MD Family Medicine Medicare: Medicare Enrolled Practice Location: 19310 S Halsted St, Glenwood, IL 60425 Phone: 708-300-3132 Fax: 708-300-3149 |