Provider Demographics
NPI:1386618833
Name:GRAMPSAS, SAMUEL ANTHONY (MD)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:ANTHONY
Last Name:GRAMPSAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 19639
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62794-9639
Mailing Address - Country:US
Mailing Address - Phone:217-545-8000
Mailing Address - Fax:844-470-2486
Practice Address - Street 1:747 N RUTLEDGE ST FL 5
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62702-6700
Practice Address - Country:US
Practice Address - Phone:217-545-8000
Practice Address - Fax:217-545-7305
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036104697208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036104697Medicaid
IL364121826 07OtherJOHN DEERE
IL340019436OtherRAILROAD MEDICARE
IL070519OtherHEALTH ALLIANCE
IL364121826 07OtherJOHN DEERE
IL971180Medicare ID - Type Unspecified
ILH48628Medicare UPIN
IL971180Medicare UPIN