| Grayslake Medical Group, Llc | |
|
900 Technology Way Ste 230 Libertyville IL 60048-5364 | |
| (847) 548-8269 | |
| (847) 548-8969 |
| Full Name | Grayslake Medical Group, Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 900 Technology Way Ste 230, Libertyville, Illinois |
| Authorized Official Name and Position | Robert Romanelli (PRESIDENT) |
| Authorized Official Contact | 8475488269 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Grayslake Medical Group, Llc 900 Technology Way Ste 230 Libertyville IL 60048-5364 Ph: (847) 548-8269 | Grayslake Medical Group, Llc 900 Technology Way Ste 230 Libertyville IL 60048-5364 Ph: (847) 548-8269 |
| NPI Number | 1437236015 |
|---|---|
| Provider Enumeration Date | 11/01/2006 |
| Last Update Date | 09/18/2018 |
| Medicare PECOS PAC ID | 8022016898 |
|---|---|
| Medicare Enrollment ID | O20061110000315 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437236015 | NPI | - | NPPES |
| 1144208554 | Other | IL | NPI/INDIVIDUAL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 036095667 (Illinois) | Primary |
| Provider Name | Robert Romanelli |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1144208554 PECOS PAC ID: 2769480532 Enrollment ID: I20061110000310 |
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