Provider Demographics
NPI:1811054828
Name:GRASSY, RICHARD GEORGE (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:GEORGE
Last Name:GRASSY
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 1:2408 WALDEN WOODS CT
Mailing Address - Street 2:
Mailing Address - City:MAHOMET
Mailing Address - State:IL
Mailing Address - Zip Code:61853-7412
Mailing Address - Country:US
Mailing Address - Phone:217-586-1859
Mailing Address - Fax:
Practice Address - Street 1:2408 WALDEN WOODS CT
Practice Address - Street 2:
Practice Address - City:MAHOMET
Practice Address - State:IL
Practice Address - Zip Code:61853-7412
Practice Address - Country:US
Practice Address - Phone:217-586-1859
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16546-020208000000X
ND5253208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics