Individual
DR. DEBORA M GRANDINETTI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
6322 N CICERO AVE, CHICAGO, IL 60646-4422
(773) 736-8088
(773) 736-4126
Mailing address
6322 N CICERO AVE, CHICAGO, IL 60646-4422
(773) 736-8088
(773) 736-4126
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036107728
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036107728
—
IL
01
—
1633642
BCBSIL
IL
Enumeration date
01/17/2007
Last updated
12/02/2009
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