Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223G0001X | General Practice | IL | |
N | 213EG0000X | General Practice | IL | |
N | 1223P0300X | Periodontist | IL |
NPI | 1023166212 |
---|---|
Provider Name | Dr. Elizabeth Louise Grys |
First Address | Brookfield, IL 60513-2314 |
Second Address | Chicago, IL 60630-1225 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/01/2007 |
Last Update Date | 08/07/2007 |