Provider Demographics
NPI:1548299340
Name:SHOWALTER, CRAIG V (MD)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:V
Last Name:SHOWALTER
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 1:1829 WINNETKA AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60093-3256
Mailing Address - Country:US
Mailing Address - Phone:847-446-6464
Mailing Address - Fax:847-446-9898
Practice Address - Street 1:1829 WINNETKA AVE
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:IL
Practice Address - Zip Code:60093-3256
Practice Address - Country:US
Practice Address - Phone:847-446-6464
Practice Address - Fax:847-446-9898
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILE33656Medicare UPIN
IL914840Medicare ID - Type Unspecified