Healthcare Provider Details

I. General information

NPI: 1245694090
Provider Name (Legal Business Name): GRACE NABIL JOSEPH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2016
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9555 76TH ST
PLEASANT PRAIRIE WI
53158-1984
US

IV. Provider business mailing address

5645 W ADDISON ST
CHICAGO IL
60634-2881
US

V. Phone/Fax

Practice location:
  • Phone: 262-671-7050
  • Fax: 262-671-7055
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberBP10057170
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036154482
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number4745320
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: