Healthcare Provider Details

I. General information

NPI: 1821101007
Provider Name (Legal Business Name): SAMUEL N. GRIEF M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 11/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1740 W TAYLOR ST
CHICAGO IL
60612-7232
US

IV. Provider business mailing address

1919 W TAYLOR ST 159 HHDSB, MC 663
CHICAGO IL
60612-7246
US

V. Phone/Fax

Practice location:
  • Phone: 866-600-2273
  • Fax:
Mailing address:
  • Phone: 312-413-4155
  • Fax: 312-996-5181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036-101419
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: