Healthcare Provider Details

I. General information

NPI: 1417961061
Provider Name (Legal Business Name): WILLIAM G GREHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 04/22/2025
Certification Date: 04/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 W NORTH AVE
MELROSE PARK IL
60160-1612
US

IV. Provider business mailing address

1121 LAKE COOK RD STE M
DEERFIELD IL
60015-5234
US

V. Phone/Fax

Practice location:
  • Phone: 708-681-3202
  • Fax:
Mailing address:
  • Phone: 847-945-4550
  • Fax: 847-948-8103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number036-082615
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number036-082615
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number89895
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: