Organization
IRMA ESPOSITO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUDY GRAVDAL M.D. (PROGRAM DIRECTOR)
(847) 723-7959
Entity
Organization
Contact information
Practice address
1775 DEMPSTER ST, PARK RIDGE, IL 60068-1143
(123) 456-7890
Mailing address
1775 DEMPSTER ST, PARK RIDGE, IL 60068-1143
(123) 456-7890
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
36121026
IL
Other
Enumeration date
08/06/2008
Last updated
08/06/2008
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