MEDICARE: DR. ROBERT GRUNSTEN 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	2084P0800X	Psychiatry Physician	036048958	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	021605461	OTHER	IL	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740393313
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT GRUNSTEN MD

Provider Business Mailing Address
First Line	:	29373 NETWORK PL
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60673-5188
Country	:	US
Telephone Number	:	847-390-5900
Fax Number	:

Provider Business Practice Location Address
First Line	:	913 W WELLINGTON AVE FL 2
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-6709
Country	:	US
Telephone Number	:	872-843-0200
Fax Number	:	872-843-9000

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

Provider Enumeration Date	:	08/16/2006
Last Update Date	:	12/21/2022

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