THOMAS GROBELNY M.D., NPI 1053388371 — CHICAGO (IL)

NPI 1053388371

13+ Years Experience Individual

THOMAS GROBELNY M.D.

03.06.2006
PROVIDER ENUMERATION DATE
10/27/2008
LAST UPDATE DATE
1053388371
NPI NUMBER

About THOMAS GROBELNY

Sole proprietor? Yes, Entity Type 1 Provider (Individual) is a Sole Proprietor.

THOMAS GROBELNY is a provider established in CHICAGO, IL. The NPI number of THOMAS GROBELNY is 1053388371 and was assigned on 03.06.2006. The practitioners primary taxonomy code is: 2085R0202X with license number: 200155001 MO .

Mailing address

  • City: CHICAGO
  • State: IL
  • Postal code: 606405265
  • Phone: 7732500500
  • Fax: 7732500497
  • Address: 4501 N WINCHESTER AVE
  • Address 2: 3RD FL

Primary Practice Address

  • Region : CHICAGO, IL
  • NPI : 1053388371
  • Phone : 7732500500
  • Fax : 7732500497
  • Postalcode : 606405265
  • Address : 4501 N WINCHESTER AVE 3RD FL

Additional identifiers

  • Identifier: 36114911
  • Code / Type : 5 - MEDICAID
  • Identifier state : IL

Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Provider taxonomy - Radiology

  • Taxonomy code: 2085R0202X
  • License number: 200155001
  • License state: MO

The taxonomy is not the primary taxonomy.

Taxonomy description: A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease.

Healthcare provider taxonomy #2 - Radiology

  • Taxonomy code: 2085R0202X
  • License number: 04-28765
  • License state: KS

The taxonomy is not the primary taxonomy.

Taxonomy description: A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease.

Contacts:

Click to Show Map
  • THOMAS GROBELNY M.D.
  • Address : 4501 N WINCHESTER AVE 3RD FL
  • Region : CHICAGO, IL
  • NPI : 1053388371
  • Phone : 7732500500
  • Fax : 7732500497
  • Postalcode : 606405265

Reference NPI Information. Full replica of the CMS (NPPES) NPI record

Field Name Value
Provider First Line Business Practice Location Address4501 N WINCHESTER AVE
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Second Line Business Practice Location Address3RD FL
The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City NameCHICAGO
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State NameIL
The State or Province name in the location address of the provider being identified.
Provider Business Practice Location Address Postal Code606405265
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Telephone Number7732500500
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number7732500497
The fax number associated with the location address of the provider being identified.
NPI1053388371
10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider.
Healthcare Provider Taxonomy 12085R0202X
A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease.
Provider Enumeration Date03.06.2006
The date the provider was assigned a unique identifier (assigned an NPI).
Last Updated10/27/2008
The date that a record was last updated or changed.
Entity TypeIndividual
Code describing the type of health care provider that is being assigned an NPI. Codes are:
  • 1 = (Person): individual human being who furnishes health care;
  • 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Provider Organization Name (Legal Business Name)THOMAS GROBELNY
Provide organization name (legal business name used to file tax returns with the IRS). The Organization Name field allows the following special characters: ampersand, apostrophe, "at" sign, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters.
Provider First Line Business Mailing Address4501 N WINCHESTER AVE
The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
Provider Second Line Business Mailing Address3RD FL
The second line mailing address of the provider being identified. This data element may contain the same information as "Provider second line location address".
Provider Business Mailing Address City NameCHICAGO
The City name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address City name".
Provider Business Mailing Address State NameIL
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
Provider Business Mailing Address Postal Code606405265
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
Provider Business Mailing Address Telephone Number7732500500
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
Provider Business Mailing Address Fax Number7732500497
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as "Provider location address fax number".
Healthcare Provider Taxonomy Code #12085R0202X
The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization.
Healthcare Provider Taxonomy 1Radiology
A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease.
Provider License Number 1200155001
Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section.
Provider License Number State Code 1MO
Healthcare Provider Primary Taxonomy Switch 1N
Primary Taxonomy:
  • X - The primary taxonomy switch is Not Answered;
  • Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
  • N - The taxonomy is not the primary taxonomy.
Healthcare Provider Taxonomy Code 22085R0202X
Healthcare Provider Taxonomy 2Radiology
A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease.
Provider License Number 204-28765
Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section.
Provider License Number State Code 2KS
Healthcare Provider Primary Taxonomy Switch 2N
Primary Taxonomy:
  • X - The primary taxonomy switch is Not Answered;
  • Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
  • N - The taxonomy is not the primary taxonomy.
Other Provider Identifier 136114911
Other Provider Identifier #1
Other Provider Identifier Type 15
  • 1 - Other
  • 5 - MEDICAID
Other Provider Identifier State 1IL
Other Provider Identifier State #1
Provider Gender CodeM
  • M - male
  • F - female
Is sole proprietorY
  • X - Not Answered
  • Y - Yes, Entity Type 1 Provider (Individual) is a Sole Proprietor
  • N - No, Entity Type 1 Provider (Individual) is not a Sole Proprietor
X

Share this page?