Individual
DR. KENNETH C GRAY SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.H.D,M.D., N.D.
Contact information
Practice address
451 MALLVIEW LN, BOLINGBROOK, IL 60440-2974
(630) 914-5065
Mailing address
451 MALLVIEW LN, BOLINGBROOK, IL 60440-2974
(630) 914-5065
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
—
—
172A00000X
Driver
—
—
174H00000X
Health Educator
—
—
175F00000X
Naturopath
Primary
—
IL
175L00000X
Homeopath
—
—
246RP1900X
Phlebotomy Technician
—
IL
247ZC0005X
Clinical Laboratory Director (Non-physician)
—
IL
367H00000X
Anesthesiologist Assistant
—
—
Other
Enumeration date
10/24/2013
Last updated
01/05/2016
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