Healthcare Provider Details

I. General information

NPI: 1417977125
Provider Name (Legal Business Name): GREGORY A GRUBB D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6250 S COTTAGE GROVE AVE
CHICAGO IL
60637-2530
US

IV. Provider business mailing address

PO BOX 2147
FORT MYERS FL
33902-2147
US

V. Phone/Fax

Practice location:
  • Phone: 312-268-6110
  • Fax: 773-834-3756
Mailing address:
  • Phone: 239-468-0260
  • Fax: 239-343-4254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036-079869
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS13529
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: