Provider Demographics
NPI:1740275015
Name:GROBELNY, WALTER R JR (MD)
Entity type:Individual
Prefix:DR
First Name:WALTER
Middle Name:R
Last Name:GROBELNY
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:700 OAK ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WINNETKA
Mailing Address - State:IL
Mailing Address - Zip Code:60093-2566
Mailing Address - Country:US
Mailing Address - Phone:847-446-1066
Mailing Address - Fax:847-446-1825
Practice Address - Street 1:700 OAK ST
Practice Address - Street 2:SUITE 200
Practice Address - City:WINNETKA
Practice Address - State:IL
Practice Address - Zip Code:60093-2566
Practice Address - Country:US
Practice Address - Phone:847-446-1066
Practice Address - Fax:847-446-1825
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-13
Last Update Date:2011-04-19
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Provider Licenses
StateLicense IDTaxonomies
IL036049787207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL110006912OtherRAILROAD MEDICARE
ILC37802Medicare UPIN
ILP01120Medicare ID - Type Unspecified