Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0203X | Pediatric Critical Care Doctor | 036.140711 | IL |
NPI | 1013250885 |
---|---|
Provider Name | Grant Richard Hahn |
First Address | Metropolis, IL 62960-1161 |
Second Address | Chicago, IL 60611-2991 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2013 |
Last Update Date | 12/08/2019 |