Individual
DR. MARK ALLEN GREVIOUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7905 CALUMET AVE, MUNSTER, IN 46321-2549
(219) 836-7506
(219) 836-7515
Mailing address
849 W OHIO ST, CHICAGO, IL 60642-6982
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
01060561A
IN
208200000X
Plastic Surgery Physician
036100551
IL
208200000X
Plastic Surgery Physician
Primary
72578
MN
208600000X
Surgery Physician
01060561A
IN
208600000X
Surgery Physician
036100551
IL
2086S0122X
Plastic and Reconstructive Surgery Physician
036100551
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036-100551-1
—
IL
Enumeration date
08/11/2005
Last updated
04/25/2025
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