Organization
GRANT ADVOCATE ILLINOIS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JERISA JOHNSON DO (PRES)
(773) 816-1117
Entity
Organization
Contact information
Practice address
441 E ERIE ST, SUITE 3712, CHICAGO, IL 60611-4446
(773) 816-1117
(773) 751-2250
Mailing address
441 E ERIE ST, SUITE 3712, CHICAGO, IL 60611-4446
(773) 816-1117
(773) 751-2250
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036119674
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036119674
—
IL
Enumeration date
11/18/2009
Last updated
11/18/2009
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