Grunberg, Mark J.

Grunberg, Mark J. is an individual health care provider with primary practice located at 3758 W Chicago Ave , Chicago IL 60651-3823. He recently has only one registered license in Dental Providers / General Practice, which is considered as his primary health care specialty. Grunberg, Mark J. can be contacted via phone (773) 276-6600.

Contact Information

Primary practice address
3758 W Chicago Ave Chicago IL 60651-3823
Phone: (773) 276-6600
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dental Providers / General Practice 1223G0001X Illinois

Profile Details

NPI number 1962407239
LBN Legal business name Grunberg, Mark J.
Credentials Doctor of Dental Surgery (DDS)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 14th, 2005
Last updated Jul 9th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1962407239 NPPES
Illinois MEDICAID 1002071

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