Provider Demographics
NPI:1619009875
Name:GROVER, MICHAEL BARRY (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:BARRY
Last Name:GROVER
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 1:2340 LINCOLNWOOD DR
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-2049
Mailing Address - Country:US
Mailing Address - Phone:847-869-4912
Mailing Address - Fax:847-869-2848
Practice Address - Street 1:2340 LINCOLNWOOD DR
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-2049
Practice Address - Country:US
Practice Address - Phone:847-869-4912
Practice Address - Fax:847-869-2848
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36-068860174400000X
IL0360688602084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No174400000XOther Service ProvidersSpecialist