| Peter Grant, Md, Ltd | |
|
1011 Lake St Suite 300 Oak Park IL 60301-1148 | |
| (708) 524-1747 | |
| Not Available |
| Full Name | Peter Grant, Md, Ltd |
|---|---|
| Speciality | Clinic/Center |
| Location | 1011 Lake St, Oak Park, Illinois |
| Authorized Official Name and Position | Peter James Grant (PHYSICIAN) |
| Authorized Official Contact | 7085241747 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Peter Grant, Md, Ltd 1131 Lake St #214 Oak Park IL 60301-1001 Ph: (708) 524-1747 | Peter Grant, Md, Ltd 1011 Lake St Suite 300 Oak Park IL 60301-1148 Ph: (708) 524-1747 |
| NPI Number | 1306032297 |
|---|---|
| Provider Enumeration Date | 09/24/2007 |
| Last Update Date | 09/24/2007 |
| Medicare PECOS PAC ID | 2163485608 |
|---|---|
| Medicare Enrollment ID | O20041105000845 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306032297 | NPI | - | NPPES |
| 03610891106 | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 036108911 (Illinois) | Primary |
| Provider Name | Peter J Grant |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1306853858 PECOS PAC ID: 8325944382 Enrollment ID: I20031210000438 |
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