Provider Demographics
NPI: | 1861456022 |
---|---|
Name: | CHAROUS, STEVEN (MD) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | STEVEN |
Middle Name: | |
Last Name: | CHAROUS |
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: | 3633 W LAKE AVE |
Mailing Address - Street 2: | SUITE 300 |
Mailing Address - City: | GLENVIEW |
Mailing Address - State: | IL |
Mailing Address - Zip Code: | 60026-5805 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 847-729-9122 |
Mailing Address - Fax: | 847-729-9134 |
Practice Address - Street 1: | 3633 W LAKE AVE |
Practice Address - Street 2: | SUITE 300 |
Practice Address - City: | GLENVIEW |
Practice Address - State: | IL |
Practice Address - Zip Code: | 60026-5805 |
Practice Address - Country: | US |
Practice Address - Phone: | 847-729-9122 |
Practice Address - Fax: | 847-729-9134 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-04-14 |
Last Update Date: | 2023-11-27 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
IL | 036084409 | 207Y00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207Y00000X | Allopathic & Osteopathic Physicians | Otolaryngology |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
IL | 01615422 | Other | BLUECROSS BLUE SHIELD |
040012421 | Other | RAILROAD MEDICARE | |
IL | 036084409 | Medicaid | |
604520 | Medicare ID - Type Unspecified | ||
IL | 214592 | Medicare PIN | |
IL | 036084409 | Medicaid |