NPIMap

Organization Active NPI

Dennis a Grollo MDSC

  • Family Medicine Physician
  • Libertyville, IL
National Provider Identifier
1487910220
Registry record updated Apr 5, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036057324 Issued in IL
Legal business name
DENNIS A GROLLO MDSC
Practice address
535 W Park Ave
Libertyville, IL 60048-2670
Phone
(847) 362-2311
Fax
(847) 362-2369
NPI assigned
Apr 5, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 5, 2012

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

Authorized official

Name
Mrs. Barbara Ann Grollo
Title
Business Manager
Phone
(847) 362-2311

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X 036057324 IL Primary

Addresses

Primary practice location

535 W Park Ave
Libertyville, IL 60048-2670

Mailing address

535 W Park Ave
Libertyville, IL 60048-2670
Phone (847) 362-2311

National Provider Directory

National Provider Directory

Locations

535 W Park Ave
Libertyville, IL 60048
Phone (847) 362-2311

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1333584000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1333584000000",
    "number": "1487910220",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "535 W PARK AVE",
            "city": "LIBERTYVILLE",
            "state": "IL",
            "postal_code": "600482670",
            "telephone_number": "847-362-2311",
            "fax_number": "847-362-2369"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "535 W PARK AVE",
            "city": "LIBERTYVILLE",
            "state": "IL",
            "postal_code": "600482670",
            "telephone_number": "847-362-2311",
            "fax_number": "847-362-2369"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENNIS A GROLLO MDSC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-05",
        "last_updated": "2012-04-05",
        "status": "A",
        "authorized_official_last_name": "GROLLO",
        "authorized_official_first_name": "BARBARA",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "847-362-2311",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036057324",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Libertyville, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2012; 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.