Provider Demographics
NPI:1770705949
Name:GRUBER, MICHAEL J (CRNA)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:GRUBER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 E HURON ST
Mailing Address - Street 2:ATTN ANESTHESIA
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2908
Mailing Address - Country:US
Mailing Address - Phone:131-292-6200
Mailing Address - Fax:
Practice Address - Street 1:251 E HURON ST
Practice Address - Street 2:ATTN ANESTHESIA
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2908
Practice Address - Country:US
Practice Address - Phone:312-926-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28159368A367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200471810AMedicaid
IL280680399Medicaid
IN000000331667OtherANTHEM BCBS
OTH000Medicare UPIN
IL280680399Medicaid