Provider Demographics
NPI:1235346941
Name:GRIMM, SEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SEAN
Middle Name:
Last Name:GRIMM
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 1:1725 W HARRISON ST STE 1010
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3841
Mailing Address - Country:US
Mailing Address - Phone:312-226-2371
Mailing Address - Fax:312-942-1783
Practice Address - Street 1:1725 W HARRISON ST STE 1010
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3841
Practice Address - Country:US
Practice Address - Phone:312-226-2371
Practice Address - Fax:312-942-1783
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-1181092084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL206147OtherMEDICARE PTAN (GROUP)
ILP01258079OtherMEDICARE RAILROAD (INDIVIDUAL)
IL206147245OtherMEDICARE PTAN (INDIVIDUAL)
IL036118109Medicaid
ILCA4748OtherMEDICARE RAILROAD (GROUP)