Healthcare Provider Details

I. General information

NPI: 1710406715
Provider Name (Legal Business Name): STEVEN R. GREENWALD MD SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2017
Last Update Date: 09/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8012 S CRANDON AVE
CHICAGO IL
60617-1124
US

IV. Provider business mailing address

PO BOX 570
LAKE FOREST IL
60045-0570
US

V. Phone/Fax

Practice location:
  • Phone: 773-356-5000
  • Fax:
Mailing address:
  • Phone: 800-444-6110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: STEVEN R GREENWALD
Title or Position: PRESIDENT
Credential: MD
Phone: 773-356-5000