Provider Demographics
NPI:1982404935
Name:GROVE DIAGNOSTIC SOLUTIONS INC
Entity type:Organization
Organization Name:GROVE DIAGNOSTIC SOLUTIONS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARCELA
Authorized Official - Middle Name:E
Authorized Official - Last Name:CORRALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-474-3944
Mailing Address - Street 1:1315 BUTTERFIELD RD STE 200
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-5602
Mailing Address - Country:US
Mailing Address - Phone:773-474-3944
Mailing Address - Fax:
Practice Address - Street 1:1315 BUTTERFIELD RD STE 200
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-5602
Practice Address - Country:US
Practice Address - Phone:773-474-3944
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-18
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty