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NPI Code Detail

MEDICARE: DR. ANTHONY GRADY

MEDICARE:  DR. ANTHONY  GRADY
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
11041C0700XClinical Social Worker149027150IL
2101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1508314352
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ANTHONY GRADY
Provider Business Mailing Address
First Line : 646 1/2 E 43RD ST
Second Line :
City : CHICAGO
State : IL
Zip : 60653-2946
Country : US
Telephone Number : 219-318-5572
Fax Number :
Provider Business Practice Location Address
First Line : 646 1/2 E 43RD ST
Second Line :
City : CHICAGO
State : IL
Zip : 60653-2946
Country : US
Telephone Number : 219-318-5572
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/21/2016
Last Update Date : 02/25/2025

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Directions to “ DR. ANTHONY GRADY ” Practice Location

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