Organization Active NPI

Graceway Medical Center LTD

  • Pediatrics Physician
  • Chicago, IL
National Provider Identifier
1962566620
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
GRACEWAY MEDICAL CENTER LTD
Practice address
4108 N Sheridan Rd
Chicago, IL 60613-2007
Phone
(773) 929-4544
Fax
(773) 929-7132
NPI assigned
Dec 20, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

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

Authorized official

Name
Lee Burstein
Title
Chief Administrative Officer
Phone
(773) 394-5260

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X IL
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X IL Primary

Addresses

Primary practice location

4108 N Sheridan Rd
Chicago, IL 60613-2007

Mailing address

3111 W Armitage Ave
Chicago, IL 60647-3818
Phone (773) 394-5260

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1166572800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1962566620",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3111 W ARMITAGE AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606473818",
            "telephone_number": "773-394-5260",
            "fax_number": "773-394-5271"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4108 N SHERIDAN RD",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606132007",
            "telephone_number": "773-929-4544",
            "fax_number": "773-929-7132"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRACEWAY MEDICAL CENTER LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-20",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "BURSTEIN",
        "authorized_official_first_name": "LEE",
        "authorized_official_title_or_position": "CHIEF ADMINISTRATIVE OFFICER",
        "authorized_official_telephone_number": "773-394-5260"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "IL",
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; 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.