Individual
CRAIG A BACKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2921 GREENBRIAR DR, SPRINGFIELD, IL 62704-6421
(217) 321-1987
(866) 594-7830
Mailing address
2921 GREENBRIAR DR, SPRINGFIELD, IL 62704-6421
(217) 321-1987
(866) 594-7830
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036065128
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
008546
HEALTH ALLIANCE
IL
01
—
020057300
BLACK LUNG
IL
05
—
036065128
—
IL
01
—
08421024
BLUE CROSS BLUE SHIELD
IL
01
—
100364
HEALTHLINK
IL
01
—
110201127
RR MEDICARE PIN
IL
01
—
133586700
ACS-OWCP
IL
01
—
14D0949277
CLIA CERT
IL
01
—
170765
PERSONAL CARE
IL
01
—
6394P
CATERPILLAR
IL
01
—
CD7143
RR MEDICARE GRP
IL
Enumeration date
07/12/2006
Last updated
09/22/2011
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