Provider Demographics
NPI:1235148206
Name:GRAEF, RONALD PETER (PHD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:PETER
Last Name:GRAEF
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3633 W LAKE AVE
Mailing Address - Street 2:STE 201B
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-5802
Mailing Address - Country:US
Mailing Address - Phone:847-724-2730
Mailing Address - Fax:847-724-2738
Practice Address - Street 1:3633 W LAKE AVE
Practice Address - Street 2:STE 201B
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-5802
Practice Address - Country:US
Practice Address - Phone:847-724-2730
Practice Address - Fax:847-724-2738
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2017-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-002640103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF300158965OtherMEDICARE PTAN
IL950630Medicare PIN