MEDICARE: DR. SANDRA LUKIC GRABA MD

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	208000000X	Pediatrics Physician	125053988	IL
2	208000000X	Pediatrics Physician	036126943	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
2	05632081	OTHER		BCBS OF IL
3	1477717213	OTHER	IL	TRICARE STANDARD

General Provider Information

NPI Number	:	1477717213
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SANDRA LUKIC GRABA MD

Provider Business Mailing Address
First Line	:	2215 SANDERS RD STE 105
Second Line	:
City	:	NORTHBROOK
State	:	IL
Zip	:	60062-6194
Country	:	US
Telephone Number	:	224-330-6300
Fax Number	:	847-854-9403

Provider Business Practice Location Address
First Line	:	525 E CONGRESS PKWY
Second Line	:
City	:	CRYSTAL LAKE
State	:	IL
Zip	:	60014-6245
Country	:	US
Telephone Number	:	815-459-6780
Fax Number	:	815-459-1648

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

Provider Enumeration Date	:	07/10/2008
Last Update Date	:	01/03/2022

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