Healthcare Provider Details

I. General information

NPI: 1417345463
Provider Name (Legal Business Name): LINDA F GRUENBERG DO SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2014
Last Update Date: 12/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 N MICHIGAN AVE SUITE 922
CHICAGO IL
60601-5311
US

IV. Provider business mailing address

307 N MICHIGAN AVE SUITE 922
CHICAGO IL
60601-5311
US

V. Phone/Fax

Practice location:
  • Phone: 312-266-5553
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. LINDA F GRUENBERG
Title or Position: PRESIDENT
Credential: D.O.
Phone: 312-266-5553