Organization
WILFREDO A GRANADA MD LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILFREDO GRANADA M.D. (PHYSICIAN)
(847) 872-5556
Entity
Organization
Contact information
Practice address
2629 SHERIDAN RD, SUITE C, ZION, IL 60099-2629
(847) 872-5556
(847) 872-5570
Mailing address
2629 SHERIDAN RD, SUITE C, ZION, IL 60099-2629
(847) 872-5556
(847) 872-5570
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
212858
MEDICARE
IL
01
—
21604808
BLUE CROSS
IL
Enumeration date
11/15/2007
Last updated
01/31/2008
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