Individual
MARK GRANT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
225 N MICHIGAN AVE, BCBSA, CHICAGO, IL 60601-7757
(312) 297-6216
Mailing address
225 N MICHIGAN AVE, BCBSA, CHICAGO, IL 60601-7757
(312) 297-6216
Taxonomy
Speciality
Code
Description
License number
State
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
036075647
IL
Other
Enumeration date
02/03/2012
Last updated
02/03/2012
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