=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396062519
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LISA NAOMI BRUNENGRABER MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/27/2010
-----------------------------------------------------
Last Update Date | 06/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 500 N MICHIGAN AVE STE 2100
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60611-3773
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-276-1212
-----------------------------------------------------
Fax | 312-276-1213
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 680 N LAKE SHORE DR STE 1200
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60611-8702
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-440-9400
-----------------------------------------------------
Fax | 312-440-0423
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | 036135240
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------