Provider Demographics
NPI:1386825537
Name:GRIBOVICH, GALINA (MD)
Entity Type:Individual
Prefix:
First Name:GALINA
Middle Name:
Last Name:GRIBOVICH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2740 W FOSTER AVE STE 207
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-3526
Mailing Address - Country:US
Mailing Address - Phone:773-878-1515
Mailing Address - Fax:773-878-2036
Practice Address - Street 1:2740 W FOSTER AVE STE 207
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-3526
Practice Address - Country:US
Practice Address - Phone:773-878-1515
Practice Address - Fax:773-878-2036
Is Sole Proprietor?:No
Enumeration Date:2007-11-15
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036105797207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036105797Medicaid