Healthcare Provider Details

I. General information

NPI: 1790177590
Provider Name (Legal Business Name): CATHERINE GRODEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2015
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5841 S MARYLAND AVE # MC6060
CHICAGO IL
60637-1443
US

IV. Provider business mailing address

1030 W MICHIGAN ST STE C4600
INDIANAPOLIS IN
46202-5201
US

V. Phone/Fax

Practice location:
  • Phone: 847-420-6605
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number70257-20
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number01083532A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: