Provider Demographics
NPI:1437114907
Name:GROSSWEINER, JAMES BENJAMIN (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:BENJAMIN
Last Name:GROSSWEINER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JAMES
Other - Middle Name:BENJAMIN
Other - Last Name:GROSSWEINER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1220 HOBSON RD STE 116
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-8137
Mailing Address - Country:US
Mailing Address - Phone:630-355-6660
Mailing Address - Fax:630-527-2856
Practice Address - Street 1:1220 HOBSON RD STE 116
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-8137
Practice Address - Country:US
Practice Address - Phone:630-355-6660
Practice Address - Fax:630-527-2856
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-074040207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2201677OtherBCBS
IL070011565OtherMEDICARE R.R.
IL036074040Medicaid
IL0300111OtherUHC