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General NPI Number Information
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NPI Number | 1902608813
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Entity Type | Individual
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Provider Name | GRACE DEVITT
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Gender |
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Dates
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Enumeration Date | 03/24/2025
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Last Update Date | 10/09/2025
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Provider Practice Location Address
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Address Line | 2160 S 1ST AVE
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City | MAYWOOD
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State | IL
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Zip | 60153-3328
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Country | US
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Telephone | 708-216-8757
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Fax |
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Provider Business Mailing Address
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Address Line | 4 CALLEVIEW DR
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City | LA GRANGE
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State | IL
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Zip | 60525-6615
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Country | US
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Telephone | 708-267-2003
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 125085586
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 125.085586
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License Number State | IL
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