Individual
LARS GRANT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1400 W PARK ST, EMERGENCY DEPARTMENT, URBANA, IL 61801-2334
(217) 337-2131
Mailing address
1400 W PARK ST, EMERGENCY DEPARTMENT, URBANA, IL 61801-2334
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
036138607
IL
207Q00000X
Family Medicine Physician
Primary
036138607
IL
Other
Enumeration date
08/13/2015
Last updated
08/13/2015
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