NPI 1083986541
Physical Medicine Clinic of Granite City LTD
Practice location
- Address
- 2861 Madison Ave, Granite City, IL 62040-3614
- Phone
- (618) 877-4000
- Mailing address
- 2980 N Beverly Glen Cir Suite 301, Los Angeles, CA 90077-1726
Authorised official
- Name
- Bud Chombirun
- Title
- Medical Director
- Phone
- (618) 877-4000
Registered specialties
Non-Pharmacy Dispensing Site
Primary
Registry record
- NPI
- 1083986541
- Entity type
- Organization
- NPI issued
- 31 Jan 2012
- Record last updated
- 31 Jan 2012
Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.