Healthcare Provider Details

I. General information

NPI: 1144250838
Provider Name (Legal Business Name): THERI GRIEGO RABY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 05/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 N MICHIGAN AVE SUITE 450
CHICAGO IL
60611-3777
US

IV. Provider business mailing address

PO BOX 11033
CHICAGO IL
60611-0033
US

V. Phone/Fax

Practice location:
  • Phone: 312-276-1212
  • Fax: 312-276-1213
Mailing address:
  • Phone: 312-276-1212
  • Fax: 312-276-1213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036-091084
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: