Provider Demographics
NPI:1619941929
Name:AKIENS, GRACE HELEN (MD)
Entity Type:Individual
Prefix:DR
First Name:GRACE
Middle Name:HELEN
Last Name:AKIENS
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 1:6763 N MILWAUKEE AVE
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-4418
Mailing Address - Country:US
Mailing Address - Phone:847-297-2181
Mailing Address - Fax:847-297-0248
Practice Address - Street 1:6763 N MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-4418
Practice Address - Country:US
Practice Address - Phone:847-297-2181
Practice Address - Fax:847-297-0248
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-074625207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036074625Medicaid
IL786950Medicare PIN
IL036074625Medicaid