Healthcare Provider Details

I. General information

NPI: 1962866913
Provider Name (Legal Business Name): ALLISON ELIZABETH GRUBBS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2016
Last Update Date: 08/01/2023
Certification Date: 08/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 E SUPERIOR ST DEPT OBGYN SUITE 5-2177
CHICAGO IL
60611-2914
US

IV. Provider business mailing address

250 E SUPERIOR ST DEPT OBGYN SUITE 5-2177
CHICAGO IL
60611-2914
US

V. Phone/Fax

Practice location:
  • Phone: 312-472-4673
  • Fax: 312-472-4687
Mailing address:
  • Phone: 312-472-4673
  • Fax: 312-472-4687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number036152844
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: