Kondowe, Crystal Vaughn

Kondowe, Crystal Vaughn is an individual health care provider with primary practice located at 375Th Medical Group 310W Losey St, Scott Afb IL 62225. She recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / General Practice, Allopathic & Osteopathic Physicians / Hospitalist, Allopathic & Osteopathic Physicians / Internal Medicine. Allopathic & Osteopathic Physicians / Internal Medicine is her primary health care specialty. Kondowe, Crystal Vaughn can be contacted via phone (618) 256-7799.

Contact Information

Primary practice address
375Th Medical Group 310W Losey St Scott Afb IL 62225
Phone: (618) 256-7799
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / General Practice 208D00000X 0101255760 Virginia
Allopathic & Osteopathic Physicians / Hospitalist 208M00000X 036139867 Illinois
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 036139867 Illinois

Profile Details

NPI number 1366702870
LBN Legal business name Kondowe, Crystal Vaughn
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 18th, 2012
Last updated Sep 1st, 2021 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1366702870 NPPES
Texas MEDICAID 1366702870

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