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Organization
GRAVNET L.L.C
Active
Organization
GRAVNET L.L.C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAY PATEL SR. D.O. (MEDICAL DIRECTOR)
(630) 481-6399
Entity
Organization
Contact information
Practice address
2608 BERSHIRE DR, CHAMPAIGN, IL 61821-5703
(630) 481-6399
Mailing address
2608 BERSHIRE DR, CHAMPAIGN, IL 61821-5703
(630) 481-6399
Taxonomy
Speciality
Code
Description
License number
State
207QA0000X
Adolescent Medicine (Family Medicine) Physician
Primary
—
NULL
207QA0000X
Adolescent Medicine (Family Medicine) Physician
Primary
—
—
207QA0505X
Adult Medicine Physician
—
NULL
207QA0505X
Adult Medicine Physician
—
—
Other
Enumeration date
11/27/2023
Last updated
11/27/2023
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