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Individual
NOEL GRANDAS
Active
Individual
NOEL GRANDAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
225400000X
Rehabilitation Practitioner
Primary
036113697
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036113697
—
IL
01
—
363236791
TAX ID #
IL
Enumeration date
11/28/2006
Last updated
08/09/2010
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