Individual
SPENCER GRANT SUPPES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
10400 HALIGUS RD, HUNTLEY, IL 60142-9553
(224) 654-0100
(224) 654-0105
Mailing address
10400 HALIGUS RD, HUNTLEY, IL 60142-9553
(224) 654-0100
(224) 654-0105
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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