Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | 036078269 | IL |
NPI | 1033163191 |
---|---|
Provider Name | Dr. Stephen Michael Grohmann |
First Address | Chicago, IL 60625-3500 |
Second Address | Chicago, IL 60625-3500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2006 |
Last Update Date | 14/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036078269 | (05) | IL |
1617297 | BLUE CROSS/BLUE SHIELD (01) | IL |
F22848 | (02) | IL |