MEDICARE: GUIDO GRASSO-KNIGHT 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	207Q00000X	Family Medicine Physician	254524	NY
2	207Q00000X	Family Medicine Physician	D71983	MD
3	390200000X	Student in an Organized Health Care Education/Training Program
4	207Q00000X	Family Medicine Physician	036-133136	IL

General Provider Information

NPI Number	:	1164644266
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GUIDO GRASSO-KNIGHT M.D.

Provider Business Mailing Address
First Line	:	3231 EUCLID AVE
Second Line	:	MACNEAL FAMILY MEDICINE RESIDENCY
City	:	BERWYN
State	:	IL
Zip	:	60402-3466
Country	:	US
Telephone Number	:	708-783-2000
Fax Number	:	708-783-3656

Provider Business Practice Location Address
First Line	:	630 E NORTH AVE
Second Line	:
City	:	CAROL STREAM
State	:	IL
Zip	:	60188-2127
Country	:	US
Telephone Number	:	630-458-5300
Fax Number	:

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

Provider Enumeration Date	:	05/02/2007
Last Update Date	:	03/17/2021

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