Provider Demographics
NPI:1366559858
Name:GRILL, STEPHEN DAMIEN (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:DAMIEN
Last Name:GRILL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1860 PAYSPHERE CIR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-0018
Mailing Address - Country:US
Mailing Address - Phone:630-833-0653
Mailing Address - Fax:630-932-3437
Practice Address - Street 1:2 TRANSAM PLAZA DR
Practice Address - Street 2:SUITE 100
Practice Address - City:OAKBROOK TERRACE
Practice Address - State:IL
Practice Address - Zip Code:60181-4823
Practice Address - Country:US
Practice Address - Phone:630-833-0653
Practice Address - Fax:630-932-3437
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036-057396207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-057396Medicaid
IL686060Medicare ID - Type Unspecified
ILC-41729Medicare UPIN