Organization
DR 247 SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LARISSA GRANOVSKI PHD (MANAGER)
(847) 949-3913
Entity
Organization
Contact information
Practice address
975 WEILAND RD, SUITE 100, BUFFALO GROVE, IL 60089-7053
(847) 947-8444
(847) 947-8435
Mailing address
975 WEILAND RD, SUITE 100, BUFFALO GROVE, IL 60089-7053
(847) 947-8444
(847) 947-8435
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
06/24/2019
Last updated
02/18/2020
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