Provider Demographics
NPI:1740740661
Name:KEENEY-BONTHRONE, GRACE CATHERINE
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:CATHERINE
Last Name:KEENEY-BONTHRONE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 SPALDING DR STE 401
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-6560
Mailing Address - Country:US
Mailing Address - Phone:630-369-7700
Mailing Address - Fax:630-369-7705
Practice Address - Street 1:120 SPALDING DR STE 401
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-6560
Practice Address - Country:US
Practice Address - Phone:630-369-7700
Practice Address - Fax:630-369-7705
Is Sole Proprietor?:No
Enumeration Date:2019-03-25
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036167773207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology