Provider Demographics
NPI:1235185299
Name:DENENBERG, GREG D (MD)
Entity Type:Individual
Prefix:
First Name:GREG
Middle Name:D
Last Name:DENENBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4905 OLD ORCHARD CTR
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-1425
Mailing Address - Country:US
Mailing Address - Phone:847-679-6707
Mailing Address - Fax:847-679-6721
Practice Address - Street 1:4905 OLD ORCHARD CTR
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-1425
Practice Address - Country:US
Practice Address - Phone:847-679-6707
Practice Address - Fax:847-679-6721
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-098295207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016-37105OtherBCBS
IL215140Medicare PIN
IL016-37105OtherBCBS