Provider Demographics
NPI:1669465936
Name:CROSSAN, PAUL D (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:D
Last Name:CROSSAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:62647 COLLECTION CENTER DR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60693-0626
Mailing Address - Country:US
Mailing Address - Phone:773-726-4713
Mailing Address - Fax:815-941-2476
Practice Address - Street 1:19060 EVERETT BLVD
Practice Address - Street 2:SUITE 112
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-1942
Practice Address - Country:US
Practice Address - Phone:708-478-4302
Practice Address - Fax:708-478-4303
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2022-02-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL0361141582085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036114158Medicaid
IL036114158Medicaid
ILIL7139008Medicare PIN
INI39585Medicare UPIN