Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | 01013 | NM |
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 01013 | NM |
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 181000392 | IL |
N | 2081P2900X | Pain Medicine | 181000392 | IL |
N | 2081S0010X | Sports Medicine | 181000392 | IL |
N | 213ES0000X | Sports Medicine | 181000392 | IL |
NPI | 1932413077 |
---|---|
Provider Name | Dr. Shante Griggs |
First Address | Chicago, IL 60616-4979 |
Second Address | Chicago, IL 60641-4001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2010 |
Last Update Date | 26/08/2021 |