Healthcare Provider Details

I. General information

NPI: 1447407655
Provider Name (Legal Business Name): ROBERT R. GRAY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ROBERT R. GRAY MD

II. Dates (important events)

Enumeration Date: 08/19/2008
Last Update Date: 03/03/2021
Certification Date: 03/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9650 GROSS POINT RD STE 2900
SKOKIE IL
60076
US

IV. Provider business mailing address

9650 GROSS POINT RD STE 2900
SKOKIE IL
60076-1214
US

V. Phone/Fax

Practice location:
  • Phone: 847-866-7846
  • Fax: 866-954-5787
Mailing address:
  • Phone: 847-866-7846
  • Fax: 866-954-5787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number036133454
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number036133454
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: