Provider Demographics
NPI:1508867730
Name:CROUCH, STEPHEN HUGH (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:HUGH
Last Name:CROUCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 88495
Mailing Address - Street 2:DEPT A
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60680-1495
Mailing Address - Country:US
Mailing Address - Phone:630-734-0200
Mailing Address - Fax:630-734-1560
Practice Address - Street 1:3815 HIGHLAND AVE
Practice Address - Street 2:ADVOCATE GOOD SAMARITAN HOSPITAL
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-1500
Practice Address - Country:US
Practice Address - Phone:630-275-5900
Practice Address - Fax:630-734-1560
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-090238207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036090238Medicaid
ILL68051Medicare ID - Type Unspecified