Provider Demographics
NPI:1417986258
Name:STORCH, GREGORY ALWORTH (MD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:ALWORTH
Last Name:STORCH
Suffix:
Gender:
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 7412011
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-2011
Mailing Address - Country:US
Mailing Address - Phone:314-454-6050
Mailing Address - Fax:855-887-7850
Practice Address - Street 1:1 CHILDRENS PL
Practice Address - Street 2:DIV PED INFECTIOUS DISEASE
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1002
Practice Address - Country:US
Practice Address - Phone:314-454-6050
Practice Address - Fax:855-887-7850
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR5901207R00000X, 2080P0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO201185915Medicaid
ILENROLLEDMedicaid
IL$$$$$$$$$Medicaid
MO440000789Medicare PIN
MO103810168Medicare PIN