Portland, Gregory

Portland, Gregory is an individual health care provider with primary practice located at 2401 Ravine Way Suite 200, Glenview IL 60025-7645. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Orthopaedic Surgery, Allopathic & Osteopathic Physicians / Sports Medicine. Allopathic & Osteopathic Physicians / Sports Medicine is his primary health care specialty. Portland, Gregory can be contacted via phone (847) 998-5680.

Contact Information

Primary practice address
2401 Ravine Way Suite 200 Glenview IL 60025-7645
Phone: (847) 998-5680
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Orthopaedic Surgery 207X00000X 036-103091 Illinois
Allopathic & Osteopathic Physicians / Sports Medicine 207XX0005X 036-103091 Illinois

Profile Details

NPI number 1265487508
LBN Legal business name Portland, Gregory
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 24th, 2006
Last updated Jan 30th, 2013 - about 11 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 1265487508 NPPES
Illinois MEDICAID 036-103091

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