Provider Demographics
NPI:1366568297
Name:JACEK GRELA M.D., S.C.
Entity type:Organization
Organization Name:JACEK GRELA M.D., S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JACEK
Authorized Official - Middle Name:
Authorized Official - Last Name:GRELA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-415-2959
Mailing Address - Street 1:10S570 GLENN DR
Mailing Address - Street 2:
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-6822
Mailing Address - Country:US
Mailing Address - Phone:708-415-2959
Mailing Address - Fax:708-636-1825
Practice Address - Street 1:1011 STATE ST
Practice Address - Street 2:SUITE 140
Practice Address - City:LEMONT
Practice Address - State:IL
Practice Address - Zip Code:60439-4768
Practice Address - Country:US
Practice Address - Phone:630-754-0141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL212928Medicare ID - Type UnspecifiedGROUP NUMBER