Organization
GRAYSLAKE MEDICAL GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT ROMANELLI M.D. (PRESIDENT)
(847) 548-8269
Entity
Organization
Contact information
Practice address
900 TECHNOLOGY WAY STE 230, LIBERTYVILLE, IL 60048-5364
(847) 548-8269
(847) 548-8969
Mailing address
900 TECHNOLOGY WAY STE 230, LIBERTYVILLE, IL 60048-5364
(847) 548-8269
(847) 548-8969
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036095667
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1144208554
NPI/INDIVIDUAL
IL
Enumeration date
11/01/2006
Last updated
09/18/2018
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