Individual
LAUREN GRANGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1725 W HARRISON ST STE 161, CHICAGO, IL 60612-3861
(312) 942-2452
Mailing address
1725 W HARRISON ST STE 161, CHICAGO, IL 60612-3861
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085011409
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
085011409
IDFPR
IL
Enumeration date
05/07/2024
Last updated
01/05/2026
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