Provider Demographics
NPI:1477717213
Name:GRABA, SANDRA LUKIC (MD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:LUKIC
Last Name:GRABA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2215 SANDERS RD STE 105
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-6194
Mailing Address - Country:US
Mailing Address - Phone:224-330-6300
Mailing Address - Fax:847-854-9403
Practice Address - Street 1:525 E CONGRESS PKWY
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-6245
Practice Address - Country:US
Practice Address - Phone:815-459-6780
Practice Address - Fax:815-459-1648
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125053988208000000X
IL036126943208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036126943Medicaid
05632081OtherBCBS OF IL
IL1477717213OtherTRICARE STANDARD