Healthcare Provider Details

I. General information

NPI: 1669402442
Provider Name (Legal Business Name): MICHELLE MARIE GROBOSKI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE MARIE BOYANCE MD

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 04/10/2025
Certification Date: 04/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2551 COMPASS ROAD SUITE 100 GLENBROOK PEDIATRICS
GLENVIEW IL
60026
US

IV. Provider business mailing address

29373 NETWORK PL
CHICAGO IL
60673-1293
US

V. Phone/Fax

Practice location:
  • Phone: 847-729-6445
  • Fax: 847-729-9707
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036113438
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: