Provider Demographics
NPI:1659575108
Name:WICK, GRADY M (MD)
Entity Type:Individual
Prefix:DR
First Name:GRADY
Middle Name:M
Last Name:WICK
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Gender:M
Credentials:MD
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Mailing Address - Street 1:120 W 22ND ST STE 300
Mailing Address - Street 2:NEPHROLOGY ASSOCIATES OF NORTHERN ILLINOIS
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-4071
Mailing Address - Country:US
Mailing Address - Phone:630-573-5000
Mailing Address - Fax:630-368-0331
Practice Address - Street 1:901 BIESTERFIELD RD
Practice Address - Street 2:SUITE 310
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-3392
Practice Address - Country:US
Practice Address - Phone:847-952-9332
Practice Address - Fax:847-952-9338
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2020-11-09
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Provider Licenses
StateLicense IDTaxonomies
IL036115166207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036115166Medicaid
IL036115166Medicaid
ILR01565Medicare PIN