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General NPI Number Information
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NPI Number | 1598121113
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Entity Type | Organization
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Legal Business Name | GRASSI RETINA MD SC
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Dates
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Enumeration Date | 01/12/2016
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Last Update Date | 07/11/2017
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Provider Practice Location Address
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Address Line | 1012 95TH ST SUITE 9
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City | NAPERVILLE
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State | IL
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Zip | 60564-5041
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Country | US
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Telephone | 630-995-3465
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Fax |
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Provider Business Mailing Address
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Address Line | 1012 95TH ST SUITE 9
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City | NAPERVILLE
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State | IL
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Zip | 60564-5041
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Country | US
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Telephone | 630-995-3465
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL A GRASSI
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Credential | M.D.
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Telephone | 630-995-3465
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207WX0107X
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Taxonomy Name | Retina Specialist (Ophthalmology) Physician
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License Number | 036115845
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License Number State | IL
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