Individual
ANGELIQUA FONSECA GRANGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
4201 MEDICAL CENTER DRIVE, MCHENRY, IL 60050
(815) 344-5000
Mailing address
4201 MEDICAL CENTER DRIVE, MCHENRY, IL 60050
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
125.084480
IL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/22/2024
Last updated
09/26/2024
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