Gravlin, Dean A

Gravlin, Dean A is an individual health care provider with primary practice located at 200 E Pennsylvania Ave Ste 105, Peoria IL 61603-3045. He recently has only one registered license in Allopathic & Osteopathic Physicians / Internal Medicine, which is considered as his primary health care specialty. Gravlin, Dean A can be contacted via phone (309) 655-7888.

Contact Information

Primary practice address
200 E Pennsylvania Ave Ste 105 Peoria IL 61603-3045
Phone: (309) 655-7888
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 036057930 Illinois

Profile Details

NPI number 1053315861
LBN Legal business name Gravlin, Dean A
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 9th, 2005
Last updated Aug 17th, 2012 - about 14 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1053315861 NPPES
Illinois MEDICAID 036057930

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