Individual
MICHAEL J GRUBER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
251 E HURON ST, ATTN ANESTHESIA, CHICAGO, IL 60611-2908
(312) 926-2000
Mailing address
251 E HURON ST, ATTN ANESTHESIA, CHICAGO, IL 60611-2908
(131) 292-6200
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
28159368A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000331667
ANTHEM BCBS
IN
05
—
200471810A
—
IN
05
—
280680399
—
IL
Enumeration date
05/03/2007
Last updated
01/23/2017
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