Individual
DAVID M GRGANTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
25 WINFIELD ROAD, WINFIELD, IL 60190-1295
(630) 260-0600
(630) 260-1370
Mailing address
25 WINFIELD ROAD, WINFIELD, IL 60190-1295
(630) 260-0600
(630) 260-1370
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036084372
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036084372
—
IL
01
—
080153636
RR MEDICARE (INDIVIDUAL)
IL
01
—
L71554
MEDICARE PTAN (INDIVIDUAL)
IL
Enumeration date
07/11/2006
Last updated
04/04/2013
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