Healthcare Provider Details

I. General information

NPI: 1164644266
Provider Name (Legal Business Name): GUIDO GRASSO-KNIGHT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 03/17/2021
Certification Date: 03/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 E NORTH AVE
CAROL STREAM IL
60188-2127
US

IV. Provider business mailing address

3231 EUCLID AVE MACNEAL FAMILY MEDICINE RESIDENCY
BERWYN IL
60402-3466
US

V. Phone/Fax

Practice location:
  • Phone: 630-458-5300
  • Fax:
Mailing address:
  • Phone: 708-783-2000
  • Fax: 708-783-3656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number254524
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD71983
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036-133136
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: