Individual
MARIA GRANZOTTI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2300 N EDWARD ST, DECATUR, IL 62526-4163
(217) 876-3000
Mailing address
PO BOX 587, DECATUR, IL 62525-0587
(800) 815-3365
(631) 321-4235
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
036083305
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036083305-1
—
IL
05
—
036083305-6
—
IL
01
—
5823820
BCBS OF ILLINOIS
IL
01
—
930108480
RAILROAD MEDICARE
IL
Enumeration date
03/05/2007
Last updated
07/13/2009
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