Healthcare Provider Details

I. General information

NPI: 1285584292
Provider Name (Legal Business Name): ELLERY GRONSKI PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2026
Last Update Date: 03/13/2026
Certification Date: 03/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 N MEACHAM RD
SCHAUMBURG IL
60173-4824
US

IV. Provider business mailing address

PO BOX 713260
CHICAGO IL
60677-1260
US

V. Phone/Fax

Practice location:
  • Phone: 630-790-1700
  • Fax: 847-439-7523
Mailing address:
  • Phone: 630-469-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085-012052
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: