KENYON JACOB GRAND

CHICAGO, IL
NPI1922567999
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy207P00000X Emergency Medicine
(Licence: IL  1922567999)
Additional Taxonomies390200000X Student in an Organized Health Care Education/Training Program
207P00000X Emergency Medicine
(Licence: GA  90937)
Enumeration Date2019-03-18
Last Update Date2022-06-17
Business Address
KENYON JACOB GRAND DO
1740 W TAYLOR ST
CHICAGO, IL 60612-7232
Phone number: 866-600-2273
Mailing Address
KENYON JACOB GRAND DO
1 E 8TH ST APT 304
CHICAGO, IL 60605-5060
Phone number: 513-550-1739