Basic Information
| Provider Information | |||||||||
| NPI: | 1861456022 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHAROUS | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3633 W LAKE AVE | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | GLENVIEW | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600265805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8477299122 | ||||||||
| FaxNumber: | 8477299134 | ||||||||
| Practice Location | |||||||||
| Address1: | 3633 W LAKE AVE | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | GLENVIEW | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600265805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8477299122 | ||||||||
| FaxNumber: | 8477299134 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/14/2006 | ||||||||
| LastUpdateDate: | 10/26/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/26/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | 036084409 | IL | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | 01615422 | 01 | IL | BLUECROSS BLUE SHIELD | OTHER | 040012421 | 01 | RAILROAD MEDICARE | OTHER | 036084409 | 05 | IL | MEDICAID |