Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208G00000X | Cardiothoracic Vascular Surgeon | 01052200 | IN |
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 036057662 | IL |
NPI | 1023074770 |
---|---|
Provider Name | Dr. John G Grieco |
First Address | Downers Grove, IL 60515 |
Second Address | Downers Grove, IL 60515 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2006 |
Last Update Date | 14/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
344390 | DUPAGE GROUP (01) | |
36057662 | (05) | IL |
526620 | COOK GROUP (01) | |
D15462 | (02) |