Individual
DR. GRANT WILSON GONZALEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
2921 MONTVALE DR, SPRINGFIELD, IL 62704-5359
(217) 787-2700
(217) 787-2715
Mailing address
2921 MONTVALE DR, SPRINGFIELD, IL 62704-5359
(217) 787-2700
(217) 787-2715
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
016005651
IL
213ES0103X
Foot & Ankle Surgery Podiatrist
POD001231
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
016005651
STATE OF ILLINOIS
IL
Enumeration date
08/31/2013
Last updated
03/07/2023
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