# GRANT ADVOCATE ILLINOIS LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1376871020
- **Authorized official:** DR. JERISA JOHNSON DO (PRES)
- **Authorized official phone:** (773) 816-1117

## Contact information

- **Practice address:** 441 E ERIE ST, SUITE 3712, CHICAGO, IL 60611-4446
- **Practice address phone:** (773) 816-1117
- **Practice address fax:** (773) 751-2250
- **Mailing address:** 441 E ERIE ST, SUITE 3712, CHICAGO, IL 60611-4446
- **Mailing address phone:** (773) 816-1117
- **Mailing address fax:** (773) 751-2250

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | 036119674 | IL | Yes |

## Other

- **Enumeration date:** 11/18/2009
- **Last updated:** 11/18/2009