Provider Demographics
NPI:1447611090
Name:GRUNENWALD, CHRISTIENNE (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTIENNE
Middle Name:
Last Name:GRUNENWALD
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 1:55 E LOOP RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60189-1938
Mailing Address - Country:US
Mailing Address - Phone:630-690-7300
Mailing Address - Fax:
Practice Address - Street 1:55 E LOOP RD
Practice Address - Street 2:SUITE 301
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60189-1938
Practice Address - Country:US
Practice Address - Phone:630-690-7300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-10
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036088346208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics