MEDICARE: PAUL J GRUNENWALD M.D.

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	207RC0000X	Cardiovascular Disease Physician	036088591	IL
2	207RI0011X	Interventional Cardiology Physician	036-088591	IL

General Provider Information

NPI Number	:	1427001627
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL J GRUNENWALD M.D.

Provider Business Mailing Address
First Line	:	800 BIESTERFIELD RD STE G01
Second Line	:
City	:	ELK GROVE VILLAGE
State	:	IL
Zip	:	60007-3372
Country	:	US
Telephone Number	:	847-981-3680
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 BIESTERFIELD RD STE G01
Second Line	:
City	:	ELK GROVE VILLAGE
State	:	IL
Zip	:	60007-3372
Country	:	US
Telephone Number	:	847-981-3680
Fax Number	:

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

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	01/24/2024

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