Provider Demographics
NPI:1689666885
Name:GRASSI, MICHAEL A (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:A
Last Name:GRASSI
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 1:1012 95TH ST STE 9
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-5040
Mailing Address - Country:US
Mailing Address - Phone:630-995-3465
Mailing Address - Fax:630-995-3622
Practice Address - Street 1:1012 95TH ST STE 9
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-5040
Practice Address - Country:US
Practice Address - Phone:630-995-3465
Practice Address - Fax:630-995-3622
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036115845207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
H84818Medicare UPIN
IA0294868Medicaid
H84818Medicare UPIN
IA34875OtherWELLMARK BCBS