Provider Demographics
NPI:1114503042
Name:GROESCHL, ROSS TAYLOR (DPM)
Entity type:Individual
Prefix:
First Name:ROSS
Middle Name:TAYLOR
Last Name:GROESCHL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:900 RAND RD STE 300
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-2359
Mailing Address - Country:US
Mailing Address - Phone:847-324-3976
Mailing Address - Fax:847-929-1154
Practice Address - Street 1:951 ESSINGTON RD
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-8439
Practice Address - Country:US
Practice Address - Phone:815-744-4551
Practice Address - Fax:815-744-4756
Is Sole Proprietor?:No
Enumeration Date:2021-03-22
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL016-006081213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist