Organization
WEST GRAND CLINIC,LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARIA GIACCHINO (ADMINISTRATOR)
(312) 636-9544
Entity
Organization
Contact information
Practice address
1851 W GRAND AVE, CHICAGO, IL 60622
(312) 455-2801
(312) 455-2802
Mailing address
1851 W GRAND AVE, CHICAGO, IL 60622
(312) 455-2801
(312) 455-2802
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
IL
Other
Enumeration date
08/29/2007
Last updated
08/29/2007
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