Grand Medical Clinic, Inc

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

036124389 Issued in IL

Legal business name

GRAND MEDICAL CLINIC, INC

Practice address

2158 W Grand Ave
Suite 101
Chicago, IL 60612-1571

Phone

(312) 733-9858

Fax

(312) 799-8661

NPI assigned

Feb 21, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Omar Garcia, MD

Title

Owner

Phone

(312) 733-9858

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Marek Gawrysz, MD

  • Family Medicine Physician
  • Chicago, IL
  • NPI 1508818055
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1298246400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1298246400000",
    "number": "1457658841",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2158 W GRAND AVE",
            "address_2": "SUITE 101",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606121571",
            "telephone_number": "312-733-9858",
            "fax_number": "312-799-8661"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2158 W GRAND AVE",
            "address_2": "SUITE 101",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606121571",
            "telephone_number": "312-733-9858",
            "fax_number": "312-799-8661"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND MEDICAL CLINIC, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-02-21",
        "last_updated": "2011-02-21",
        "status": "A",
        "authorized_official_last_name": "GARCIA",
        "authorized_official_first_name": "OMAR",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "312-733-9858",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": "IL",
            "license": "036124389",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Grand Michigan Dentistry, PC
• Grand Pharmacy LLC
• Grand Smiles 2
• Grand Vein Specialists LLC
• Amy Grand, RN

• Surgery Physician in Chicago, IL
• Providers in Chicago, IL by specialty
• Surgery Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.