Healthcare Provider Details

I. General information

NPI: 1699829044
Provider Name (Legal Business Name): MARIKA LAZO GREIFF MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 04/22/2015
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

912 S WOOD ST 855 NPI, M/C 796
CHICAGO IL
60612-4300
US

V. Phone/Fax

Practice location:
  • Phone: 866-600-2273
  • Fax:
Mailing address:
  • Phone: 312-996-6496
  • Fax: 312-996-4169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P0004X
TaxonomySpinal Cord Injury Medicine Physician
License Number036-094902
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: