Healthcare Provider Details

I. General information

NPI: 1649408030
Provider Name (Legal Business Name): GREGORY ALAN HENKLE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2009
Last Update Date: 02/10/2025
Certification Date: 02/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20201 CRAWFORD AVE
OLYMPIA FIELDS IL
60461-1010
US

IV. Provider business mailing address

35318 EAGLE WAY
CHICAGO IL
60678-0353
US

V. Phone/Fax

Practice location:
  • Phone: 708-679-2310
  • Fax:
Mailing address:
  • Phone: 317-528-4800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number036.117562
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: