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Organization
KING, LTD
Active
Organization
KING, LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GARTRELL D KING M.D. (OWNER)
(773) 505-6120
Entity
Organization
Contact information
Practice address
9332 S VANDERPOEL AVE, CHICAGO, IL 60643-5852
(773) 505-6120
(847) 622-8048
Mailing address
9332 S VANDERPOEL AVE, CHICAGO, IL 60643-5852
(773) 505-6120
(847) 622-8048
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
036056245
IL
207R00000X
Internal Medicine Physician
Primary
036056245
IL
Other
Enumeration date
04/14/2010
Last updated
04/14/2010
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