MEDICARE: DR. MARIUS DORIN GRADIANU D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	036154553	IL
2	207W00000X	Ophthalmology Physician	5101020454	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	036.154553	OTHER	IL	ILLINOIS STATE LICENSE

General Provider Information

NPI Number	:	1144665878
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARIUS DORIN GRADIANU D.O.

Provider Business Mailing Address
First Line	:	152 N ADDISON AVE
Second Line	:
City	:	ELMHURST
State	:	IL
Zip	:	60126-2821
Country	:	US
Telephone Number	:	630-833-9621
Fax Number	:

Provider Business Practice Location Address
First Line	:	152 N ADDISON AVE
Second Line	:
City	:	ELMHURST
State	:	IL
Zip	:	60126-2821
Country	:	US
Telephone Number	:	630-833-9621
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2013
Last Update Date	:	05/18/2023

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