Individual
DR. DARA GRENNAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
403 E 1ST ST, DIXON, IL 61021
(815) 285-5629
(815) 285-5634
Mailing address
680 N LAKE SHORE DR, CHICAGO, IL 60611-4546
(312) 956-8686
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
036-137502
IL
207RI0200X
Infectious Disease Physician
Primary
036-137502
IL
208M00000X
Hospitalist Physician
36.137502
IL
208M00000X
Hospitalist Physician
8153445
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036137502
—
IL
01
—
F400440732
MEDICARE PTAN
IL
Enumeration date
03/29/2010
Last updated
04/26/2021
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