Healthcare Provider Details

I. General information

NPI: 1548901846
Provider Name (Legal Business Name): WARREN ALEXANDER GRUNVALD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2022
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

836 W WELLINGTON AVE
CHICAGO IL
60657-5147
US

IV. Provider business mailing address

808 S WOOD ST
CHICAGO IL
60612-7300
US

V. Phone/Fax

Practice location:
  • Phone: 773-296-7054
  • Fax: 773-296-7818
Mailing address:
  • Phone: 312-355-0865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036178784
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: