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General NPI Number Information
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NPI Number | 1215004874
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Entity Type | Organization
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Legal Business Name | GRAYSLAKE FAMILY HEALTH CENTER SC
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Dates
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Enumeration Date | 11/29/2006
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Last Update Date | 01/22/2014
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Provider Practice Location Address
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Address Line | 1475 E BELVIDERE RD SUITE 312
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City | GRAYSLAKE
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State | IL
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Zip | 60030-2012
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Country | US
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Telephone | 847-845-7213
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Fax | 312-694-0655
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Provider Business Mailing Address
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Address Line | 1475 E BELVIDERE RD SUITE 312
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City | GRAYSLAKE
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State | IL
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Zip | 60030-2012
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Country | US
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Telephone | 847-584-5721
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Fax | 312-964-1468
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Authorized Official
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Title or Position | PHYSICIAN PRESIDENT
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Name | DR. ALISON S HOLLOWAY
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Credential | MD
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Telephone | 847-548-8430
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036098167
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License Number State | IL
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