Healthcare Provider Details

I. General information

NPI: 1669465936
Provider Name (Legal Business Name): PAUL D CROSSAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 02/07/2025
Certification Date: 02/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19060 EVERETT BLVD SUITE 112
MOKENA IL
60448-1942
US

IV. Provider business mailing address

62647 COLLECTION CENTER DR
CHICAGO IL
60693-0626
US

V. Phone/Fax

Practice location:
  • Phone: 708-478-4302
  • Fax: 708-478-4303
Mailing address:
  • Phone: 773-726-4713
  • Fax: 815-941-2476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number036114158
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: