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General NPI Number Information
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NPI Number | 1679580039
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Entity Type | Individual
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Provider Name | JEFFREY ALLEN GRINBLATT MD
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Gender | Male
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Dates
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Enumeration Date | 08/01/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 9669 KENTON AVE SUITE 203
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City | SKOKIE
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State | IL
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Zip | 60076-1266
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Country | US
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Telephone | 847-677-0212
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Fax |
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Provider Business Mailing Address
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Address Line | 6148 N MONTICELLO AVE
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City | CHICAGO
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State | IL
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Zip | 60659-1113
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Country | US
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Telephone | 773-539-0642
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 036081091
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License Number State | IL
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