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Individual

MARY ELLEN GRUSZKA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
8711 W CERMAK RD, NORTH RIVERSIDE, IL 60546-1166
(708) 442-7979
(708) 442-8574
Mailing address
PO BOX 967, TINLEY PARK, IL 60477-0967

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
036061958
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
036061958
IL
Enumeration date
08/24/2005
Last updated
06/29/2015
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