Healthcare Provider Details

I. General information

NPI: 1134623895
Provider Name (Legal Business Name): CHRISTOPHER GREB MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2018
Last Update Date: 06/26/2023
Certification Date: 06/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 W HARRISON STREET STE 970
CHICAGO IL
60612-3828
US

IV. Provider business mailing address

1725 W HARRISON STREET STE 970
CHICAGO IL
60612-3828
US

V. Phone/Fax

Practice location:
  • Phone: 312-942-6979
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125.075689
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number036165118
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: