Individual
TANNER L COLEGROVE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
900 N WESTMORELAND RD, SUITE # 207, LAKE FOREST, IL 60045-1674
(847) 234-9110
(847) 234-0900
Mailing address
900 N WESTMORELAND RD, SUITE # 207, LAKE FOREST, IL 60045-1674
(847) 234-9110
(847) 234-0900
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4915052
IL BLUE CROSS BLUE SHIELD
IL
Enumeration date
02/22/2007
Last updated
07/09/2007
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