1053514489 NPI number — DR. BILL H GRIMM PH.D.

Table of content: DR. BILL H GRIMM PH.D. (NPI 1053514489)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053514489 NPI number — DR. BILL H GRIMM PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRIMM
Provider First Name:
BILL
Provider Middle Name:
H
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053514489
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13114 SHREFFLER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLAINFIELD
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60585-7867
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-254-0634
Provider Business Mailing Address Fax Number:
815-254-0635

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6912 MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 29
Provider Business Practice Location Address City Name:
DOWNERS GROVE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60516-3447
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-963-9381
Provider Business Practice Location Address Fax Number:
815-254-0635
Provider Enumeration Date:
06/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 281045 . This is a "VALUEOPTIONS PROVIDER NO." identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 022-73039 . This is a "BCBSIL PROVIDER NUMBER" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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