MEDICARE: DR. DANIEL H GRUENSTEIN MD

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	208000000X	Pediatrics Physician	48460	MN
2	2080P0202X	Pediatric Cardiology Physician	48460	MN

General Provider Information

NPI Number	:	1518911288
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL H GRUENSTEIN MD

Provider Business Mailing Address
First Line	:	5841 S MARYLAND AVE
Second Line	:	MC 4051
City	:	CHICAGO
State	:	IL
Zip	:	60637-1447
Country	:	US
Telephone Number	:	773-702-6172
Fax Number	:	773-702-2319

Provider Business Practice Location Address
First Line	:	5841 S MARYLAND AVE
Second Line	:	MC 4051
City	:	CHICAGO
State	:	IL
Zip	:	60637-1447
Country	:	US
Telephone Number	:	773-702-6172
Fax Number	:	773-702-2319

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

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	01/06/2016

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