Individual
MISS KIZHEL GRANZON TAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CSRS
Contact information
Practice address
3919 W FOSTER AVE, CHICAGO, IL 60625-6056
(773) 588-9500
Mailing address
2629 W HOWARD ST, CHICAGO, IL 60645-1406
(312) 965-9409
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
070021083
IL
Other
Enumeration date
12/17/2018
Last updated
12/17/2018
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