MEDICARE: THERI GRIEGO RABY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	036-091084	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144250838
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THERI GRIEGO RABY M.D.

Provider Business Mailing Address
First Line	:	PO BOX 11033
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-0033
Country	:	US
Telephone Number	:	312-276-1212
Fax Number	:	312-276-1213

Provider Business Practice Location Address
First Line	:	500 N MICHIGAN AVE
Second Line	:	SUITE 450
City	:	CHICAGO
State	:	IL
Zip	:	60611-3777
Country	:	US
Telephone Number	:	312-276-1212
Fax Number	:	312-276-1213

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	05/11/2012

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