| Grant Advocate Illinois Llc | |
|
441 E Erie St Suite 3712 Chicago IL 60611-4446 | |
| (773) 816-1117 | |
| (773) 751-2250 |
| Full Name | Grant Advocate Illinois Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 441 E Erie St, Chicago, Illinois |
| Authorized Official Name and Position | Jerisa Johnson (PRES) |
| Authorized Official Contact | 7738161117 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Grant Advocate Illinois Llc 441 E Erie St Suite 3712 Chicago IL 60611-4446 Ph: (773) 816-1117 | Grant Advocate Illinois Llc 441 E Erie St Suite 3712 Chicago IL 60611-4446 Ph: (773) 816-1117 |
| NPI Number | 1376871020 |
|---|---|
| Provider Enumeration Date | 11/18/2009 |
| Last Update Date | 11/18/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376871020 | NPI | - | NPPES |
| 036119674 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 036119674 (Illinois) | Primary |
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