Individual
NOEL GRANDAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5000 S 5TH AVE, HINES, IL 60141-3030
(708) 202-2282
(708) 202-2281
Mailing address
5000 S 5TH AVE, HINES, IL 60141-3030
(708) 202-2282
(708) 202-2281
Taxonomy
Speciality
Code
Description
License number
State
225400000X
Rehabilitation Practitioner
Primary
036113697
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036113697
—
IL
01
—
363236791
TAX ID #
IL
Enumeration date
11/28/2006
Last updated
08/09/2010
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