Healthcare Provider Details

I. General information

NPI: 1548754674
Provider Name (Legal Business Name): DANNIELLE GRAYER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2018
Last Update Date: 06/29/2022
Certification Date: 06/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 E HURON ST # 1-200
CHICAGO IL
60611-2909
US

IV. Provider business mailing address

2317 W GRENSHAW ST UNIT 1
CHICAGO IL
60612-4205
US

V. Phone/Fax

Practice location:
  • Phone: 312-503-7975
  • Fax:
Mailing address:
  • Phone: 317-629-6521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number125073279
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125073279
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: