Individual
MS. LISA GRAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
815 W 63RD ST, CHICAGO, IL 60621-1917
(877) 926-3936
Mailing address
815 W 63RD ST FL 4, CHICAGO, IL 60621-1917
(877) 926-3936
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
84-5111204
IL
Other
Enumeration date
08/06/2025
Last updated
08/06/2025
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