Gravdal, Judith Ann
Gravdal, Judith Ann is an individual health care provider with primary practice located at 1775 Ballard Rd , Park Ridge IL 60068-1005. She recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as her primary health care specialty. Gravdal, Judith Ann can be contacted via phone (847) 318-6020.Contact Information
Primary practice address
1775 Ballard Rd
Park Ridge IL 60068-1005
Phone: (847) 318-6020
Fax: (847) 318-2712
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | 036060860 | Illinois |
Profile Details
| NPI number | 1437194594 |
|---|---|
| LBN Legal business name | Gravdal, Judith Ann |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 20th, 2006 |
| Last updated | Dec 16th, 2021 - about 3 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1437194594 | NPPES |
| Illinois | MEDICAID | 036060860 | |
| Illinois | Other | 036060860 |
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