Provider Demographics
NPI:1639259641
Name:MENAKER, GREGG M (MD)
Entity type:Individual
Prefix:
First Name:GREGG
Middle Name:M
Last Name:MENAKER
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Gender:M
Credentials:MD
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Mailing Address - Street 1:2650 RIDGE AVE
Mailing Address - Street 2:EVANSTON HOSPITAL
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-1718
Mailing Address - Country:US
Mailing Address - Phone:847-570-1644
Mailing Address - Fax:847-733-5315
Practice Address - Street 1:9977 WOODS DR
Practice Address - Street 2:3RD FLOOR
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-1057
Practice Address - Country:US
Practice Address - Phone:847-663-8062
Practice Address - Fax:847-663-1027
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2020-12-08
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Provider Licenses
StateLicense IDTaxonomies
IL036103610207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILG67351Medicare UPIN
ILL81922Medicare PIN