Provider Demographics
NPI:1942533070
Name:CROSS, CHADRICK ANTONY (MD)
Entity Type:Individual
Prefix:DR
First Name:CHADRICK
Middle Name:ANTONY
Last Name:CROSS
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 1:9500 BORMET DR STE 204
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-8399
Mailing Address - Country:US
Mailing Address - Phone:708-346-4044
Mailing Address - Fax:708-346-3287
Practice Address - Street 1:4400 W 95TH ST STE 308
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2660
Practice Address - Country:US
Practice Address - Phone:708-346-4040
Practice Address - Fax:708-346-3287
Is Sole Proprietor?:No
Enumeration Date:2009-09-08
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01069493A208G00000X
WI58016-20208G00000X
IL036120936208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN2010299720DMedicaid
MI1942533070Medicaid
IL036120936Medicaid
IN2010299720AMedicaid
IN2010299720CMedicaid
IN2010299720EMedicaid
IN2010299720BMedicaid
IL969780006Medicare PIN
IL535550007Medicare PIN
IN2010299720AMedicaid
IN2010299720BMedicaid
IN2010299720CMedicaid