Healthcare Provider Details

I. General information

NPI: 1023074770
Provider Name (Legal Business Name): JOHN G GRIECO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 02/14/2020
Certification Date: 02/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 WARRENVILLE RD SUITE 280
DOWNERS GROVE IL
60515
US

IV. Provider business mailing address

2650 WARRENVILLE RD SUITE 280
DOWNERS GROVE IL
60515
US

V. Phone/Fax

Practice location:
  • Phone: 630-324-7900
  • Fax: 630-324-7942
Mailing address:
  • Phone: 630-324-7900
  • Fax: 630-324-7942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number01052200
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number036057662
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: