Individual
SPENCER GRANT SUPPES
Active
Individual
SPENCER GRANT SUPPES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
036161712
IL
390200000X
Student in an Organized Health Care Education/Training Program
125.076420
IL
Other
Enumeration date
05/12/2020
Last updated
09/27/2024
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