Individual
MR. GLEN DERRICK TRAMMELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1901 W HARRISON ST, CHICAGO, IL 60612-3714
(773) 869-7488
Mailing address
3248 186TH ST, HOMEWOOD, IL 60430-2798
(773) 869-7488
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085-000875
IL
Other
Enumeration date
04/10/2007
Last updated
04/30/2021
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