Dean A Gravlin M.D.

NPI 1053315861 - Internal Medicine - 207R00000X

NPI Details
NPI 1053315861
Gender Male
Enumeration Date 06/09/2005
Last Updated 08/17/2012
Entity Type Individual
Active Over 11 years ago
Practice Location
200 E PENNSYLVANIA AVE
STE 105
PEORIA IL, 61603-3045, US
Phone (309) 655-7888
Fax
Business Location
200 E PENNSYLVANIA AVE
STE 105
PEORIA IL, 61603-3045, US
Phone (309) 655-7888
Fax
Toxanomy
Taxonomy Code 207R00000X
License State Illinois
License Number 036057930
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According to our database, Dean A Gravlin M.D. NPI is 1053315861, taxonomy code is 207R00000X and license number is 036057930, license state is located at Illinois. Dean A Gravlin M.D. physically located at 200 E Pennsylvania Ave, Peoria IL, 61603-3045. NPI Number Dean A Gravlin M.D. has the Individual type.

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1053315861 NPI number is provided on an as is basis without warranty of any kind. 1053315861 is maintained by the National Plan & Provider Enumeration System. The contents of Dean A Gravlin M.D. are for informational purposes only.