Provider Demographics
NPI:1831237502
Name:GRUENBERG, LINDA F (DO)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:F
Last Name:GRUENBERG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 N. MICHIGAN AVE.,
Mailing Address - Street 2:STE 922
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601
Mailing Address - Country:US
Mailing Address - Phone:312-266-5553
Mailing Address - Fax:312-332-3933
Practice Address - Street 1:307 N. MICHIGAN AVE
Practice Address - Street 2:SUITE 922
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601
Practice Address - Country:US
Practice Address - Phone:312-266-5553
Practice Address - Fax:312-332-3933
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-0851832084P0800X, 2084F0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036085183Medicaid
F49790Medicare UPIN
IL331390Medicare PIN
IL036085183Medicaid