Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | 036082262 | IL |
NPI | 1063434256 |
---|---|
Provider Name | James Stephen Grober |
First Address | Evanston, IL 60201-1718 |
Second Address | Evanston, IL 60201-1777 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2006 |
Last Update Date | 06/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036-082262 | (05) | IL |
1620385 | BCBS PPO (01) | IL |
660002720 | RAILROAD MEDICARE (01) | IL |
E16064 | (02) |