Healthcare Provider Details

I. General information

NPI: 1235112798
Provider Name (Legal Business Name): JOY GROHAR MS CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5525 S PULASKI RD
CHICAGO IL
60629-4417
US

IV. Provider business mailing address

2525 S MICHIGAN AVE B-390
CHICAGO IL
60616-2333
US

V. Phone/Fax

Practice location:
  • Phone: 773-585-1955
  • Fax: 773-284-5268
Mailing address:
  • Phone: 312-567-6691
  • Fax: 312-328-7895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: