Healthcare Provider Details

I. General information

NPI: 1477558377
Provider Name (Legal Business Name): ANTHONY A GRANDE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4309 W. MEDICAL CENTER DR. SUITE B202
MCHENRY IL
60050
US

IV. Provider business mailing address

711 W DEVON
PARK RIDGE IL
60068-4713
US

V. Phone/Fax

Practice location:
  • Phone: 847-535-6083
  • Fax: 815-759-6284
Mailing address:
  • Phone: 847-696-3176
  • Fax: 847-696-2678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number036081102
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: