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Individual

MARTIN EDWARD GRYFINSKI

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1340 CHARLES ST, SUITE 400, ROCKFORD, IL 61104
(779) 696-9512
Mailing address
PO BOX 78866, MILWAUKEE, WI 53278-8866
(779) 696-7150
(779) 696-7342

Taxonomy

Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
036-071919
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
01915166
BLUE CROSS/BLUE SHIELD
IL
05
036071919
IL
01
197958
HEALTH ALLIANCE
IL
01
P00971760
RAILROAD MEDICARE
IL
Enumeration date
08/20/2006
Last updated
07/25/2018
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