Healthcare Provider Details

I. General information

NPI: 1467398412
Provider Name (Legal Business Name): GRANT SCHLUNTZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 W HARRISON ST STE 758
CHICAGO IL
60612-3863
US

IV. Provider business mailing address

1725 W HARRISON ST STE 758
CHICAGO IL
60612-3863
US

V. Phone/Fax

Practice location:
  • Phone: 312-942-3640
  • Fax:
Mailing address:
  • Phone: 312-942-3640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209036054
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: