=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114503042
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROSS TAYLOR GROESCHL DPM
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/22/2021
-----------------------------------------------------
Last Update Date | 09/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 951 ESSINGTON RD
-----------------------------------------------------
City | JOLIET
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60435-8439
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-744-4551
-----------------------------------------------------
Fax | 815-744-4756
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 900 RAND RD STE 300
-----------------------------------------------------
City | DES PLAINES
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60016-2359
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-324-3976
-----------------------------------------------------
Fax | 847-929-1154
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number | 1351
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number | 016-006081
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------