Organization
BDC KANSAS CITY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DUWAYNE GRIEPENTROG (COMPTROLLER)
(847) 688-2888
Entity
Organization
Contact information
Practice address
3001 6TH ST STE A, GREAT LAKES, IL 60088-2833
(847) 688-4560
Mailing address
3001 6TH ST STE A, GREAT LAKES, IL 60088-2833
(847) 688-4560
Taxonomy
Speciality
Code
Description
License number
State
261QM1100X
Military/U.S. Coast Guard Outpatient Clinic/Center
Primary
—
—
Other
Enumeration date
08/30/2007
Last updated
08/30/2007
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