Healthcare Provider Details

I. General information

NPI: 1124607320
Provider Name (Legal Business Name): EMILY ANN ENRIQUEZ DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMILY ANN GRIGG

II. Dates (important events)

Enumeration Date: 04/05/2021
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 RAND RD
DES PLAINES IL
60016-1005
US

IV. Provider business mailing address

29373 NETWORK PL
CHICAGO IL
60673-1293
US

V. Phone/Fax

Practice location:
  • Phone: 847-294-5490
  • Fax: 847-640-4450
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036-170102
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036-170102
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: