Individual
RANDALL D GRANT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
2800 W 95TH ST, EVERGREEN PARK, IL 60805-2701
(518) 542-0860
Mailing address
2800 W 95TH ST, EVERGREEN PARK, IL 60805-2701
(518) 542-0860
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
02007636A
IN
207P00000X
Emergency Medicine Physician
Primary
036142144
IL
207P00000X
Emergency Medicine Physician
34.014212
OH
Other
Enumeration date
07/06/2010
Last updated
04/22/2026
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