Healthcare Provider Details

I. General information

NPI: 1679032510
Provider Name (Legal Business Name): MATTHEW ROBERT GRACZYK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2019
Last Update Date: 07/11/2024
Certification Date: 07/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1622 WILLOW RD STE 200
NORTHFIELD IL
60093-3450
US

IV. Provider business mailing address

1622 WILLOW RD STE 200
NORTHFIELD IL
60093-3450
US

V. Phone/Fax

Practice location:
  • Phone: 847-853-0234
  • Fax:
Mailing address:
  • Phone: 847-853-0234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number036159516
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number036159516
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: