Provider Demographics
NPI:1144250838
Name:RABY, THERI GRIEGO (MD)
Entity type:Individual
Prefix:
First Name:THERI
Middle Name:GRIEGO
Last Name:RABY
Suffix:
Gender:F
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 11033
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-0033
Mailing Address - Country:US
Mailing Address - Phone:312-276-1212
Mailing Address - Fax:312-276-1213
Practice Address - Street 1:500 N MICHIGAN AVE
Practice Address - Street 2:SUITE 450
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3777
Practice Address - Country:US
Practice Address - Phone:312-276-1212
Practice Address - Fax:312-276-1213
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-091084207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-091084Medicaid
IL036-091084Medicaid
I38782Medicare UPIN